Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 56 (2), 89-96

Transforaminal Epidural Steroid Injections Prevent the Need for Surgery in Patients With Sciatica Secondary to Lumbar Disc Herniation: A Retrospective Case Series

Affiliations

Transforaminal Epidural Steroid Injections Prevent the Need for Surgery in Patients With Sciatica Secondary to Lumbar Disc Herniation: A Retrospective Case Series

Neil A Manson et al. Can J Surg.

Abstract

Background: The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery.

Methods: We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers' compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery.

Results: We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers' compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI.

Conclusion: Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.

Figures

Fig. 1
Fig. 1
(A) Sagittal view magnetic resonance imaging scan demonstrating L4/5 disc herniation. (B) Perineural injection of iohexol confirming L5 nerve root location.
Fig. 2
Fig. 2
Median wait times (2009) from referral by a general practitioner (GP) to treatment grouped by specialty. Provided by The Fraser Institute’s National Waiting List Survey, 2009 (www.fraserinstitute.org/).
Fig. 3
Fig. 3
Summary of variables and their association with primary (surgical requirement) and secondary (workers’ compensation status, demographic characteristics) outcomes. LDH = lumbar disc herniation; SD = standard deviation;TFESI = transforaminal steroid injection.
Fig. 4
Fig. 4
The percentage of patients who did and did not require surgical intervention after the first and second injections.
Fig. 5
Fig. 5
Number of patients receiving workers’ compensation who did and did not require surgery.
Fig. 6
Fig. 6
Means and standard deviations for appointment time-lines. Time to effective treatment was statistically different.

Similar articles

See all similar articles

Cited by 7 PubMed Central articles

See all "Cited by" articles
Feedback