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Anesth Analg 2007;104:1217-1222
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260307.16555.7f

PAIN MEDICINE

The Efficacy of Lumbar Epidural Steroid Injections in Patients with Lumbar Disc Herniations

William E. Ackerman, III, MD*, and Mahmood Ahmad, MD{dagger}

From the *Pain Medicine Consultants P.A., Little Rock, Arkansas 72223 and {dagger}United Pain Care Inc., Sherwood, Arkansas 72120.

Address correspondence to William E. Ackerman, III, Pain Medicine Consultants P.A., Little Rock, Arkansas 72223. Address e-mail to William.Ackerman{at}bhsi.com.

INTRODUCTION: Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations.

METHODS: Ninety patients aged 18–60 years with L5-S1 disk herniations and radicular pain were randomly assigned to one of these groups to have epidural steroid injection therapy every 2 wk for a maximum of three injections. Pain relief, disability, and activity levels were assessed.

RESULTS: Pain relief was significantly more effective with TF injections. At 24 wk from the initiation of this study, pain relief was as follows: C: complete pain relief: 1/30, partial pain relief: 16/30, and no relief: 13/30; IL: complete pain relief: 3/30, partial pain relief: 15/30, and no relief: 12/30; and TF: complete pain relief: 9/30, partial pain relief: 16/30, and no relief: 5/30.

CONCLUSIONS: The TF route of epidural steroid placement is more effective than the C or IL routes. We attribute this observation to a higher incidence of steroid placement in the ventral epidural space when the TF method is used.




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 Anesth. Analg.Home page
K. D. Candido, M. S. Raghavendra, M. Chinthagada, S. Badiee, and D. W. Trepashko
A Prospective Evaluation of Iodinated Contrast Flow Patterns with Fluoroscopically Guided Lumbar Epidural Steroid Injections: The Lateral Parasagittal Interlaminar Epidural Approach Versus the Transforaminal Epidural Approach
Anesth. Analg., February 1, 2008; 106(2): 638 - 644.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.