Radicular pain in post lumbar surgery syndrome: the significance of transforaminal injection of steroids

Pain Med. 2013 Feb;14(2):243-6. doi: 10.1111/j.1526-4637.2012.01463.x. Epub 2012 Aug 8.

Abstract

Objective: The objective of the study was to see if transforaminal injection of steroids might be an effective treatment for persistent radicular pain after disc surgery.

Design: The study was designed as a retrospective practice audit covering a time period of 2 years.

Setting: The study was set in a single spine center in which all patients underwent lumbar disc surgery, postoperative follow-up, and subsequent treatment.

Interventions: Patients with postsurgical radicular pain were treated with a transforaminal injection of a steroid. The effect was evaluated in terms of pain reduction, duration of pain relief, and in relation to a recurrent disc herniation in postperative magnetic resonance imaging.

Results: Of 479 patients who underwent microsurgical lumbar disc surgery, 69 had persistent radicular pain. Transforaminal injection of steroid achieved pain reduction of at least 50% in 26.8% of these patients. The success rate was higher (43%) in patients without a recurrent disc herniation.

Conclusions: Transforaminal injection of steroid appears to be effective in only a minority of patients with radicular pain persisting after disc surgery, but is more often effective in patients without recurrent disc herniation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Bupivacaine / administration & dosage
  • Bupivacaine / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Humans
  • Injections
  • Intervertebral Disc Degeneration / surgery*
  • Intervertebral Disc Displacement / surgery*
  • Lumbar Vertebrae
  • Male
  • Middle Aged
  • Neuralgia / drug therapy*
  • Neuralgia / etiology
  • Neurosurgical Procedures / adverse effects*
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Radiculopathy / drug therapy
  • Radiculopathy / etiology
  • Retrospective Studies
  • Treatment Outcome
  • Triamcinolone / administration & dosage
  • Triamcinolone / therapeutic use*
  • Young Adult

Substances

  • Anesthetics, Local
  • Anti-Inflammatory Agents
  • Triamcinolone
  • Bupivacaine

Supplementary concepts

  • Intervertebral disc disease