ࡱ > d g c [ bjbj ; ΐ ΐ V V և N U W W W W W W $ $ Ƌ ^ { { U U y w X } Z A 0 և 1~ F $ t $ w w J $ { { և $ V _ : Background: The purpose of this prospective, randomized study is to compare the efficacy of two different routes in administering epidural steroid injections interlaminar (IL) vs. transforaminal (TF) in patients with chronic unilateral lumbar radicular pain. Methods: We randomly enrolled and followed 64 patients with chronic radicar pain. In order to be included in the study patients had to have unilateral lumbosacral radicular leg pain that was greater than the back pain and unresponsive to at least 6 weeks of conservative management and absence of motor or bowel/bladder impairment. Patients had to have VAS pain score of 5 or higher to undergo epidural injections. Patients received a series of three interlaminar or transforaminal lumbar epidural steroid injections, spaced 2 weeks apart. Patients were then followed and assessed at each visit at three and six months following the first injection. Results: Significant improvements were maintained throughout six months (24 weeks) of follow-up. The average VAS pain scores at 24 weeks improved to 4.02.2 cm in IL group and 3.82.1 Baseline functional capacity was comparable for IL and TF group (52% vs 53 % ) when assessed using Oswestry score. At 6 months both groups improved suggesting change from severe to moderate disability scoring range (Oswestry score 39% for IL group and 38% for TF group). There were 24 out of 32 (75%) patients in IL Group at 24 weeks who improved more than 2 cm on VAS scale and 17 patients (53%) had >50% of the pain relief. In TF group there were 27 out of 32 (84%) patients with >2 cm improvement on VAS pain scale and 20 of 32 (63%) with > 50% improvement at 24 weeks. There werent difference in other characteristic between interlaminar i transforaminal group after six months observation. Conclusions: Using either route of epidural injections to deliver steroids for unilateral chronic radicular pain provided significant improvements in patient function the intensity of pain in both groups (IL and TF), but no statistic significance exists between the indicated groups, although steroids delivered via TF route provided somewhat better long-term pain relief and functional capacity improvements then via IL route in patients with chronic radiculopathy.
Key Words: epidural steroid injections, radicular pain, fluoroscopy
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