Evaluation of Transforaminal Epidural Steroid Injection in Radicular Low Back Pain According to MSU Classification

Başakşehir Çam & Sakura City Hospital160 enrolled

Overview

Low back pain is a common disease in all ages and it effects seriously quality of life. Medical treatment,interventional methods and surgery are the treatment options. Transforaminal epidural steroid injections (TFSI) is one of the interventional method for radiculopathy with low back pain. Michigan State University(MSU) classification is a MRI based disc herniation classification. It helps to classified disc herniation in types, places and sizes. The aim of this study to evaluate the pain and oswestry disability index in patients who have radiculopathy with low back pain, undergone TFSI according to MSU classification.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

160

Conditions

Radiculopathy Lumbar Low Back Pain Disc Herniation Injections, Epidural

Transforaminal Epidural Steroid InjectionPROCEDURE

Epidural injections have been used since about 1900 for the treatment of low back and lower extremity pain, with steroids added to local anesthetics in about 1950. The epidural space can be entered by 3 approaches: caudal, interlaminar, and transforaminal. Transforaminal Epidural Steroid Injections: After the patient is monitored in pron position and asepsis is ensured, the epidural space is entered with the appropriate needle through the transforaminal space by giving the necessary angles to the fluoroscopy. Then the location is confirmed with radiopaque agent and steroid injection is performed. The procedure takes 15-20 minutes.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * between the ages of 18-65 * After outpatient evaluation, a decision was made to perform transforaminal steroid injection, * Low back pain of more than 6 on a numeric rating scale (NRS) * Radiculopathy for more than 4 weeks and less than one year and straight leg raising \<45 * Disc herniation at the L4-L5 or L5-S1 level on MRI * Failure to respond to medical treatment for at least one month Exclusion Criteria: * Neurological deficit, * Bleeding problems, * Localized infection, * Spinal pathologies (such as tumors), * Fractures, * Severe stenosis, * Uncontrolled diabetes, * Pregnancy, * Red flag symptoms (such as motor and/or sphincter dysfunction) * Patient reluctance, * Computed tomography (CT) and MRI findings in favor of sequestrated fragments from herniated disc, * Sphincteric disorders, * Previous spine surgeries

Outcomes

Primary Outcomes

Change of the pain severity score

Pain severity is assessed by using "Numeric Rating Scale" (NRS). Patients give score of their pain between 0 (no pain) and 10 (worst possible pain). The change in NRS scores between the ten groups will be compared.

Time frame: Pre-intervention, post-intervention 1th month and post-intervention 3rd month

Change of the disability score

Disability conditions of the patients are assessed by using "Oswestry Disability Index" (ODI). ODI is a patient completed questionnaire which gives a percentage score of disability. The ODI is comprised of 10 items and enquires about functional limitations in various activities of daily living with the index score ranging from 1 (best) to 100 (worst). The change in ODI scores between the ten groups will be compared.