• Kai-Uwe Lewandrowski.
• Center for Advanced Spine Care of Southern Arizona, United States; Surgical Institute of Tucson, United States. Electronic address: business@tucsonspine.com.
• Clin Neurol Neurosurg. 2018 Oct 1; 173: 38-45.

ObjectiveTo analyze the positive predictive value of diagnostic 1% lidocaine containing transforaminal epidural steroid injections (TESI) for successful outcome after outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis.Patients And MethodsA retrospective study of 1839 consecutive patients with an average mean follow-up of 33 months that underwent endoscopic transforaminal decompression at 2076 lumbar levels was conducted. The sensitivity, specificity, and positive predictive value of lidocaine containing diagnostic TESI at the intended surgical level were calculated based on the recorded frequency of >50% VAS score reduction, intraoperatively visualized stenosis, and clinical outcomes assessed by Macnab criteria and VAS reduction.ResultsOf the 1839 patients, 1750 had intraoperatively visualized stenosis in the lateral recess at the surgical level and 89 patients did not. Analyzing recordings of diagnostic TESI responses in patients with visualized compressive pathology: true positive (1578); false negative (172); as compared with TESI responses in patients without visualized compressive pathology: false positive (26); and true negative (63) allowed for calculation of sensitivity (90.17%), specificity (70.79%), and the positive predictive value (98.38%) of preoperative lidocaine containing TESI in relation to successful clinical outcome of the subsequent endoscopic decompression surgery.ConclusionsThe expected VAS pain reduction (>50%) from a lidocaine containing transforaminal epidural steroid injection renders it a valuable diagnostic tool in improving clinical outcome after lumbar endoscopic transforaminal decompression.Copyright © 2018 Elsevier B.V. All rights reserved.

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