Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis.

OBJECTIVES

The purpose of this study is to compare the effectiveness of interlaminar (IL) and bilateral transforaminal (TF) epidural steroid injections (ESIs) for pain reduction in patients with axial back pain resulting from herniated intervertebral disc (HIVD) and spinal stenosis (SS).

METHODS

Patients reporting axial back pain without radiation continuing over 3 months, which resulted from lumbosacral SS or HIVD were recruited and assigned to either the IL or TF technique group. The degree of pain and patient satisfaction were evaluated by the Numerical Rating Scale (NRS), the Patient Satisfaction Index (PSI), and the Roland 5-point pain score, which were administered at pretreatment, 2 weeks, 2 months, and 4 months after ESI.

RESULTS

Both the TF and IL ESIs accomplished significant pain reduction in HIVD and SS from 2 weeks to 4 months after treatment. SS showed a more significant reduction in the Roland 5-point pain score and obtained more successful NRS results using the TF technique as compared with the IL technique. HIVD did not show any differences between the techniques.

DISCUSSION: Bilateral TF epidural injection allowed the higher concentration of injectates to be delivered into ventral epidural space bilaterally. The IL approach can be more affected by tissue fibrosis, scarring, or hypertrophy, which is more prominently featured in SS than in HIVD; these prevent the injectate delivered via the posterior route from spreading to the ventral epidural space. Consequently, in patients with SS, bilateral TF produces better results than IL.