The effectiveness of volume versus concentration of the epidural steroid injections through transforaminal approach

BackgroundThe use of transforaminal epidural injections under fluoroscopy guarantees the proper delivery of steroids to the target site with the least volume. The aim of this study was to compare the effects of different volumes of epidural steroid injections for treatment of sciatica through transforaminal approach.Methods60 ASA I–II patients complaining of unilateral radiculopathy were divided randomly into three equal groups (group A–C), to be given transforaminal injection under fluoroscopy. All patients received a mixture of (80 mg methylprednisolone acetate + 1 ml contrast dye of Omnipaque 300) plus 1 ml of 0.5% bupivacaine (group A), or 2 ml of 0.5% bupivacaine (group B), or 3 ml of 0.5% bupivacaine (group C).ResultsThere was significant reduction in the (VAS) score, at 60 minutes (group A 2.3 ± 1.1, group B 2.7 ± 0.8 and group C 3 ± 0.8 p < 0.01). Patients in group A had significantly lower VAS score (3.9 ± 1) in relation to the groups B VAS score (4.7 ± 1.1) and C (5 ± 1.1) two weeks after the injection (p < 0.01).In group A, sixteen patients showed a significant reduction in the frequency of analgesic intake in the follow up period, while eleven patients reduced the frequency of analgesic intake during the 2 weeks follow up period, in group B. As for group C, twelve patients remained on the same frequency of analgesic intake following injection. Patients in group A showed significant reduction in the need for surgery.ConclusionPatients receiving a low volume and high concentration of corticosteroid via transforaminal epidural approach for the treatment of symptomatic lumbar disc herniation or spinal stenosis had significantly better short-term pain improvement, and less incidence of need for surgical intervention, than patients who were treated with a diluted solution of corticosteroid.