Abstract
The purpose of this study was to assess the outcome of peri-radicular infiltration for radicular pain in patients with spinal stenosis and lumbar disc herniation (LDH). Patients with spinal stenosis (n=62) or LDH (n=55) who met our criteria received fluoroscopically guided peri-radicular infiltration of local anaesthetic and steroid at the site of documented pathology. All the patients were followed-up at 3 months. There was a statistically significant difference in the functional outcome between the spinal stenosis group and the LDH group. The mean change in the Oswestry disability index (ODI) score for the spinal stenosis group was 5.5% compared to 12% for the LDH group. The spinal stenosis group had a mean change in visual analogue scales (VAS) of 1.2 compared to 2 for the LDH group. The higher the modified somatic perception score, modified zung depression and age at injection, the less favourable the outcome. There was a significantly better response to peri-radicular infiltration for radicular pain in patients with LDH than the spinal stenosis. Our findings help us to provide a better information for future patients. We do not know if this is a treatment effect or natural history of the pathology, as this is a cohort study and not a randomised controlled trial.
Similar content being viewed by others
References
Bogduk N (1995) Epidural steroids. Spine 20:845–848
Bogduk N, Brazenor G, Christophides N, Cherry D, Fraser R, Jenkins J, et al (1993) Epidural steroids in the management of low back pain and sciatica of spinal origin. Report of the working party. National Health and Medical Research Council, Sydney, pp 102–106
Botwin KP, Gruber RD, Bouchlas CG (2002) Fluroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 81: 898–905
El-khouri GY, Ehara S, Weinstein JN, Montgometry WJ, Kathol MH (1998) Epidural steroids injection: a procedure ideally performed with fluoroscopic control. Radiology 168:554–557
Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Fisher R, Johnston M (1997) Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following and its relationship with other aspects of the chronic pain experience. Physiother Theory Practice 13:67–80
Franson RC, Saal JS, Saal JA (1992) Human disc phospholipase A2 is inflammatory. Spine 17:S129–S132
Holt AE, Shaw NJ, Shett YA, Greenough CG (2002) The reliability of the low back outcome score for back pain. Spine 27:206–210
Johansson A, Hao J, Sjolund B (1990) Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand 34:335–338
Johnsson KE, Rosen I, Uden A (1993) The natural course of lumbar stenosis. Acta Orthop Scand (Suppl) 251:67–69
Karppinen J, Malmivaara A, Kurunlahti M, Kyllonen E, Pienimaki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Peri-radicular infiltration for sciatica: a randomised controlled trial. Spine 26:1059–1067
Kikuchi S, Hasue M (1998) Combined contrast studies in lumbar spine disease: Myelography (peridurography) and nerve root infiltration. Spine 13:1327–1331
Koes BW, Scholten R, Mens J, Bouter LM (1995) Efficacy of epidural injections for low-back pain and sciatica: a systemic review of randomised clinical trials. Pain 63:279–288
Krempen JF, Smith BS (1974) Nerve root injection. A method for evaluating the etiology of sciatica. J Bone Joint Surg Am 56:1435–1444
Lutz GE, Vad VB, Wisneski RJ (1998) Fluroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 79:1362–1366
Macnab I (1971) Negative disc exploration: an analysis of the causes of nerve root involvement in sixty-eight patients. J Bone Joint Surg Am 53:891–903
Main CJ (1983) The modified somatic perception questionnaire (MSPQ). J Psychosom Res 27:503–514
Main CJ, Waddell G (1987) Personality assessment in the management of low back pain. Clin Rehabil 1:139–142
Main CJ, Wood PLR, Hollis S, et al (1992) The distress and risk assessment method: a simple patient classification to identify distress and evaluate the risk of poor outcome. Spine 17:42–52
McCarron RF, Wimpee MW, Hudkins PG, Laros GS (1987) The inflammatory effect of nucleus pulposus: a possible element in the pathogenesis of low back pain. Spine 12:760–764
Nygaard OP, Mellgren SI, Osterud B (1997) The inflammatory properties of contained and non-contained lumbar disc herniation. Spine 22:2484–2488
Olmarker K, Rydevik B (1991) Pathophysiology of sciatica. Orthop Clin North Am 22:223–234
Olmarker K, Byrod G, Cornefjord M, Norborg C, Rydevik B (1994) Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine 19:1803–1808
Olmarker K, Blomquist J, Stromberg J, Nannmark U, Thomsen P, Rydevik B (1995) Inflammatogenic properties of nucleus pulposus. Spine 20:665–669
Ozaki T, Kurihara A, Sha N, et al (1993) Clinical study of conservative and operative treatment in lumbar spinal stenosis. International society of the study of the lumbar spine, Marseille
Pfirrmann CW, Oberholzer PA, Zanetti M, Boos N, Trudell DJ, Resnick D, Hodler J (2001) Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectiveness—A study with patients and cadavers. Radiology 221:704–711
Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K (2000) The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg Am 82:1589–1593
Shah R, Vad V, Lutz G, et al (2000) Transforaminal epidural injections in lumbar radiculopathy: prospective randomised trials. Proceedings of the North American Spine Society, 15th Annual Meeting. American Spine Society, New Orleans, pp 44–45
Tajima T, Furukawa K, Kuramochi E (1980) Selective lumbosacral radiculopathy and block. Spine 5:68–77
Tief P, Grant W, Fredickson B (2000) A prospective study of psychological predictors of lumbar surgery outcome. Spine 25:2616–2621
Watanabe R, Parke WW (1986) Vascular and neural pathology of lumbarsacral spinal stenosis. J Neurosurg 64:64–70
Weber H, Holme I, Amber E (1993) The natural course of acute sciatica with nerve root symptoms in a double blind placebo controlled trial evaluating the effects of piroxicam. Spine 18:1433–1438
Weiner BK, Fraser RD (1997) Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br 79:804–807
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ng, L.C.L., Sell, P. Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis. Eur Spine J 13, 325–329 (2004). https://doi.org/10.1007/s00586-003-0649-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-003-0649-1