FLUOROSCOPIC TRANSFORAMINAL LUMBAR EPIDURAL STEROIDS - AN OUTCOME STUDY

Objectives: To determine the therapeutic value and longterm effects of fluoroscopic transforaminal epidural steroid injections in patients w ith refractory radicular leg pain. Background Data: Although numerous studies have evaluated the efficacy of traditional transsacral (caudal ) or translaminar (lumbar) administration of epidural steroids, to our knowledge no studies have assessed specifically the therapeutic value of fluoroscopic transforaminal epidural steroids. Study Design: A pro spective case series that investigated the outcome of patients with lu mbar herniated nucleus pulposus and radiculopathy who received fluoros copic transforaminal epidural steroid injections. Methods: patients wh o met our inclusion criteria received fluoroscopically guided, contras t-enhanced transforaminal epidural administration of anesthetic and st eroid directly at the level and side of their documented pathology. Pa tients were evaluated by an independent observer and received sequenti al questionnaires before and after injection, documenting pain level, activity level, and patient satisfaction. Results: Sixty-nine patients met our inclusion criteria and were followed for an average period of 80 weeks (range, 28 to 144 weeks); 75.4% of patients had a successful long-term outcome, reporting at least a >50% reduction between preinj ection and postinjection pain scores, as well as an ability to return to or near their previous levels of functioning after only 1.8 injecti ons per patient (range, 1 to 4 injections). Of our patients, 78.3% wer e satisfied with their final outcomes. Conclusions: Fluoroscopic trans forminal epidural steroids are an effective nonsurgical treatment opti on for patients with lumbar herniated nucleus pulposus and radiculopat hy in whom more conservative treatments are not effective and should b e considered before surgical intervention. (C) 1998 by the American Co ngress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.