EVALUATING THE USE OF TRANSFORAMINAL EPIDURALS IN THE TREATMENT PATHWAY OF LUMBAR RADICULAR PAIN. A REVIEW OF A SINGLE SURGEON'S PRACTICE OVER A 4 YEAR PERIOD

Background and Aims

Transforaminal epidurals (TFEs) have been widely used as a treatment for lumbar radicular pain since its introduction by Krempen and Smith in 1974¹. Originally used as a diagnostic tool, it is now becoming increasingly recognised as a definitive treatment². This study investigates the use of TFEs by a single surgeon over 4 years. We hoped that the study would add to our understanding and the discussion of the actual benefit of therapeutic steroid and local anaesthetic injections by this route³.

Methods and Results

A total of 181 patients were identified. At injection 10mls 0.25% Marcaine and 40mg Depomedrone was injected under fluoroscopic guidance. Clinic notes and MRI reports for all patients were reviewed.

Of the 176 patients included in the study, 127 showed a symptomatic improvement. Of these patients, 59 proceeded to surgical decompression. For 50 patients, TFE was the definitive treatment. 13 patients were offered but declined surgery. 5 patients were too frail to proceed to surgery.

49 patients showed no symptomatic improvement. Of this group, 34 were deemed unsuitable for surgical intervention. 15 patients did proceed to surgery.

Conclusions and Discussion

These results are comparable to other similar case series. Vad et al³ demonstrated that 78% of patients studied were satisfied with the outcome of TFE. Riew et al² showed that 53% of their study group avoided surgery due to positive long term effect of TFE.

The operative notes of the 15 patients who proceeded to surgery despite a negative TFE outcome are being reviewed and will be presented.

Conflicts of Interest

None

Source of Funding

None