Comparison of Unilateral and Bilateral Transforaminal Epidural Steroid Injections in Unilateral Lumbar Disc Herniation: A Randomized Controlled Trial.

Objective

To compare the efficiency of unilateral and bilateral transforaminal epidural steroid injections (TFESI) in patients with unilateral lumbar disc herniation (LDH).

Methods

In this prospective randomized single-blinded study, patients with unilateral LDH were randomly divided into two groups: A unilateral TFESI group; and a bilateral TFESI group. The severity of pain and disability were assessed with the Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 1 week, 1 month, and 3 months after interventions. Treatment response was defined as ≥50% reduction in the NRS-11 at the 3-month follow-up. Changes in medication consumption at 3 months following the interventions were recorded. This study protocol is registered at ClinicalTrials.gov (NCT06240793).

Results

A total of 104 patients were included in the study (n = 58 in the unilateral TFESI group and n = 46 in the bilateral TFESI group). The NRS-11, ODI scores and medical treatment consumption did not differ statistically between the groups at 3 months (p ˃ 0.05). At 3 months, the rates of patients with a > 50% decrease in NRS-11 scores were 13.8% and 32.6% in the unilateral TFESI group and bilateral TFESI group, respectively.

Conclusions

Unilateral and bilateral TFESI both decrease pain severity and disability scores to a similar degree, although bilateral TFESI was more effective in reducing pain severity by over 50% in patients with single-level unilateral LDH.