OBSERVATIONS ON THERAPEUTIC TRANSFORAMINAL EPIDURAL STEROID INJECTIONS FOR LUMBOSACRAL NERVE ROOT PAIN

BACKGROUND Low back pain combined with radicular pain is one of the most challenging musculoskeletal problems for therapeutic management with a lifetime prevalence estimated to be around 40% to 60%. We wanted to observe the results of therapeutic transforaminal epidural steroid injection for lumbosacral nerve root pain with regard to pain relief, patient satisfaction and improvement in return to work status before and after the injection. METHODS This study was conducted in the post-graduate department of orthopaedics, Govt. Hospital for Bone and Joint Surgery, an associated hospital of Govt. Medical College, Srinagar from Sept. 2016 to Sept. 2018. The study consisted of a total of 100 patients. Patient was explained in detail about the Visual Analogue Scale (VAS) and Oswestry Questionnaire. RESULTS A total of 100 patients with 53 % males 47 % females was included in this study. The mean age was 40.3 years. 59 % of patients had right sided radiculopathy and 41% had it on left side. The average duration of symptoms was 4.13 months with standard deviation of 0.788. The average pre injection SLR was 59.20(0) which increased post injection to an average of 85.35(0)(p-value<0.001). 88 of the patients had a lateral disc herniation and central prolapse of disc (4%) on MRI. 42% received L5 TFESI followed by S1 (40%). Mean VAS before injection was 5.98 with S.D. of +/- 1.359. The mean VAS after 6 months was 2.25 +/- 1.316. Mean pre-injection ODI was 32.95 (S.D. of 8.26). After TFESI, it dropped to 11.91 at 1 week, 12.03 at 4 weeks and increased a bit to 15.63 with S.D. of 5.03. p-value<0.001. 63% of our patients had excellent outcome, 33% had good, 3% had fair and 1% had poor outcome as measured by modified McNab scale. CONCLUSIONS Transforaminal epidural steroid injection is an effective alternative method of pain control with improvement in disability with excellent patient satisfaction in properly selected patients of lumbosacral radiculopathy.