Background: Lumbar disc herniation (LDH) is a common disease in clinical practice. The symptoms recur and are aggravated by time; severe pain and long-term movement disorder cause physiological and psychological problems that affect the quality of life of patients. Therefore, relieving the pain symptoms and promoting functional recovery are the primary goals that have gained increased attention.
Objective: To assess the efficacy of CT-guided transforaminal epidural steroid injection (TFESI) combined with pulsed radio frequency (PRF) on spinal nerve root for the treatment of LDH.
Study design: Retrospective comparative study.
Setting: Shengjing Hospital of China Medical University.
Methods: A total of 135 patients with LDH were selected from the Department of Pain Management in the Shengjing Hospital of China Medical University between January 2014 and December 2016. All patients were divided into three groups according to the order of entry (n=45): TFESI (group A); PRF on spinal nerve root (group B); and TFESI combined with PRF on spinal nerve root (group C). The visual analog scale (VAS), Oswestry disability index (ODI), and global perceived effect (GPE) before treatment and at different time points after treatment were observed, and patients' satisfaction was assessed.
Results: At every point of observation, the VAS and ODI decreased significantly as compared to that before treatment in all groups (P<0.05). The VAS and ODI in group A at 3 and 6 months after treatment were significantly higher than that in the other two groups (P<0.05). At day 1, day 14, and 1 month after treatment, the VAS and ODI in group C were significantly lower than that in group B (P<0.05). The GPE in group C was high in the early days, while that at day 14 and 1 month after treatment was significantly higher than that in the other two groups (P<0.05); no significant difference was observed in GPE at 3 and 6 months after treatment between groups B and C (P>0.05).
Conclusion: TFESI combined with PRF for the treatment of LDH could effectively and rapidly relieve lumbago and radicular pain and achieve long-term remission. Although the method is widely applicable, the precise selection of patients is imperative.
Keywords: low back pain; lumbar disc herniation; pulsed radio frequency; radicular pain; spinal nerve root; transforaminal epidural steroid injection.
Conflict of interest statement
Disclosure The authors report no conflicts of interest in this work.
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The effectiveness of transforaminal epidural steroid injections on radicular pain, functionality, psychological status and sleep quality in patients with lumbar disc herniation.J Back Musculoskelet Rehabil. 2017;30(2):265-270. doi: 10.3233/BMR-150438. J Back Musculoskelet Rehabil. 2017. PMID: 27858682
CT-guided nucleoplasty with radiofrequency energy for the treatment of lumbar disk herniation.J Spinal Disord Tech. 2015 Feb;28(1):E9-16. doi: 10.1097/BSD.0000000000000132. J Spinal Disord Tech. 2015. PMID: 25023711 Clinical Trial.
Clinical evaluation of transforaminal epidural steroid injection in patients with gadolinium enhancing spinal nerves associated with disc herniation.Pain Physician. 2015 Mar-Apr;18(2):E177-85. Pain Physician. 2015. PMID: 25794217
Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: a case series and review.J Back Musculoskelet Rehabil. 2014;27(2):181-90. doi: 10.3233/BMR-130434. J Back Musculoskelet Rehabil. 2014. PMID: 24254495 Review.
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- Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769–781. - PubMed
- Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33(22):2464–2472. - PubMed
- Zentner J, Schneider B, Schramm J. Efficacy of conservative treatment of lumbar disc herniation. J Neurosurg Sci. 1997;41(3):263–268. - PubMed
- El-Yahchouchi C, Wald J, Brault J, et al. Lumbar transforaminal epidural steroid injections: does immediate post-procedure pain response predict longer term effectiveness? Pain Med. 2014;15(6):921–928. - PubMed