• Chan Hong Park, Sang Ho Lee, and Hahck Soo Park.
• Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu, South Korea.
• Pain Physician. 2011 Jul 1;14(4):353-60.

BackgroundLumbar transforaminal epidural steroid injections (TFESIs) are procedures often utilized in the treatment of radicular pain. TFESIs with a preganglionic approach have been reported to be more effective than TFESIs performed using a classic approach. However, it is unknown whether TFESIs using a retrodiscal approach are as effective as other approaches.ObjectiveTo investigate the effect of an epidural steroid injection (ESI) on radicular pain, we conducted a randomized, controlled trial comparing a retrodiscal approach with a classic approach to treat lumbar disc herniation.DesignA case control study.MethodsForty patients were randomized to receive lumbar TFESIs with either a retrodiscal approach (n=20) or with a classic approach (n=20). Measurements were taken before as well as 4 and 8 weeks after treatment using a visual analog scale (VAS) score, Patient Satisfaction Index (PSI) and the Roland 5-point pain score.ResultsIn the retrodiscal group, there was a statistically significant improvement in the VAS score after injection compared to baseline. In the classic group, there was a statistically significant improvement in the VAS score after injection compared to baseline. There was no statistically significant difference in the VAS score, PSI, or the Roland 5-point pain score between those treated with a retrodiscal approache and those treated with a classic approach.LimitationsSecondary outcomes were not measured and the study did not include a mid- or long-term follow-up period.ConclusionIn this study, TFESIs performed using a retrodiscal or classic approach had similar effects on radicular pain. The classic and the retrodiscal transforaminal steroid injection resulted in equivalent pain relief.

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