Lumbar retrodiscal versus post-ganglionic transforaminal epidural steroid injection for the treatment of lumbar intervertebral disc herniations

Background: lumbar 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. objective: to 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. design: a case control study. methods: forty 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. results: in 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. limitations: secondary outcomes were not measured and the study did not include a midor long-term follow-up period. conclusion: in 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.