Epidural Steroid Injections in Post-lumbar Surgery Syndrome After Single-level Discectomy

Marmara University62 enrolled

Overview

62 patients with postlumbar surgery syndrome were randomized and divided into two groups. Transforaminal epidural steroid injection (TFESI) was applied to the TFESI group (n=31), and caudal epidural steroid injection (CESI) was applied to the CESI group (n=31). The age of the patients involved in this study ranged from 18 years old to 65 years old

Patients with low back and radicular pain related to epidural fibrosis following single-level lumbar discectomy were included. The patients were randomly divided into two groups as the CESI group and TFESI group. Transforaminal epidural steroid injection was applied to the TFESI group (n=31), and caudal epidural steroid injection was applied to the CESI group (n=31). All patients were assessed before the procedure (baseline) and at 1 hour, three weeks, and three months after the procedure using the Numerical Rating Scale (NRS) and at baseline and three weeks and three months using the modified Oswestry Disability Index (mODI). Treatment success was defined as ≥50% decrease in the NRS scores compared to baseline

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Failed Back Surgery Syndrome Low Back Pain Radiculopathy Epidural Fibrosis

Interventions

Transforaminal epidural steroid injectionPROCEDURE

Caudal epidural steroid injectionPROCEDURE

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 65 years * Previous single-level, open, non-fusion discectomy for L4-5 or L5-S1 lumbar disc herniation within the past six months * Having epidural fibrosis involving the L4, L5 or S1 nerve root on magnetic resonance imaging * Having low back and leg pain for at least six months and unresponsive to conservative therapies * A Numerical Rating Scale score of ≥4 * Having a single-level epidural fibrosis in the operated level and side as assessed by contrast-enhanced spinal magnetic resonance imaging Exclusion Criteria: * Having a multi-level epidural fibrosis * Previous surgery for multi-level disc herniation * Previous lumbar fusion surgery * Having recurrent disc hernia * Having sacroiliac/facet joint pain * Having lumbar spinal stenosis, spondylolysis, spondylolisthesis, or scoliosis * History of epidural steroid injection within the past six months * Having bleeding diathesis * Presence of systemic or local infections * Pregnancy * Known hypersensitivity to the injectates to be applied

Locations (1)

Marmara University Pendik Training and Research Hospital

Istanbul, Turkey (Türkiye)

Outcomes

Primary Outcomes

Change in pain severity

Numerical Rating Scale (NRS) is a scale for assessing the severity of pain. The numerical rating scale ranges from 0 to 10, with 0 being "no pain" and 10 being "worst pain imaginable". The patient chooses the most appropriate number describing the severity of pain (oral version).

Time frame: All patients were assessed from baseline to each checkpoint (at 1 hour, three weeks, and three months after the procedure)

Change in disability score

Modified Oswestry Disability Index (MODI) is a 10-question questionnaire assessing disability in low back pain. Each question has 6 options. The lowest score for each question is zero and the highest score is 5. High score is associated with increased disability.

Time frame: All patients were assessed from baseline to each checkpoint (at 1 hour, three weeks, and three months after the procedure)

Data from ClinicalTrials.gov

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