Clinical effectiveness of single lumbar transforaminal epidural steroid injections

Pain Med. 2013 Aug;14(8):1126-33. doi: 10.1111/pme.12122. Epub 2013 Apr 22.


Objectives: To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy.

Design: Retrospective observational series.

Setting: Single academic radiology pain management practice.

Subjects: Two thousand twenty-four subjects undergoing single lumbar TFESIs at the L4-5, L5-S1, or S1 neural foramina.

Methods / outcome measures: Subjects were assessed with a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M, 23-point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow-up. Successful pain relief (responders) was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R-M score.

Results: There were statistically significant (P < 0.0001) reductions in mean NRS and R-M scores at 2 weeks and 2 months postinjection. For NRS, 40.9% were responders at 2 weeks and 45.6% at 2 months. For R-M, 31.9% were responders at 2 weeks and 41.3% at 2 months. The proportion of responders for NRS and R-M was higher when there was <3 months of pain (odds ratio 2-month NRS = 2.42 [95% confidence interval: 1.82, 3.24], odds ratio 2-month R-M = 2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4% (56.5, 68.3%) for NRS and 59.3% (53.3, 65.3%) for R-M scores.

Conclusions: This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.

Keywords: Effectiveness; Epidural; Lumbar; Pain; Radicular; Spine; Steroid.

MeSH terms

  • Adult
  • Aged
  • Back Pain / drug therapy*
  • Cohort Studies
  • Databases, Factual
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Epidural / methods*
  • Logistic Models
  • Lumbar Vertebrae
  • Lumbosacral Region
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Retrospective Studies
  • Steroids / administration & dosage*
  • Steroids / therapeutic use*
  • Surveys and Questionnaires
  • Treatment Outcome


  • Steroids