Comparison of Efficacy between Transforaminal Epidural Steroid Injection Technique without Contrast versus with Contrast in Lumbar Radiculopathy: A Prospective Longitudinal Cohort Study

Abstract

Study Design A prospective longitudinal cohort study. Purpose To evaluate the efficacy of two different techniques of transforaminal epidural steroid injection (TFESI) with contrast and without contrast in treating lumbar radiculopathy. Overview of Literature Epidural injections are one of the most frequently used nonsurgical treatment options for managing lumbar radiculopathy. This study aims to simplify the TFESI technique, which is effective and requires less effort to replicate. Methods We collected data on 118 patients who underwent TFESI without contrast versus TFESI with contrast for lumbar radiculopathy. The pain was evaluated using a Numerical Rating Scale (NRS) for pain at 5 minutes, 2 hours, 2 weeks, and 2 months. The functional status was assessed using the Oswestry Disability Index (ODI) score. The operation time and fluoroscopic dosage were also measured using this score. Results Two groups of patients with radiculopathy were studied, comprising of 56 patients in the non-contrast group (NC group) and 62 patients in the contrast group (C group). There was a significant decrease in pain, as evaluated by NRS, in the C group compared to the NC group at 5 minutes post-procedure (3.39±1.54 vs. 3.86±0.72, with a p-value of 0.039). There was no significant difference in NRS scores at 2 hours, 2 weeks, and 2 months, as well as in ODI scores. The operation time and fluoroscopic dosage were lower in the group without contrast compared to the contrast group, with 12.58±3.30 minutes per level vs. 16.70±5.94 minutes per level (p<0.001) and 3.62±1.66 mGy vs. 5.32±2.74 mGy per level (p=0.014), respectively. No complications were reported in either group. Conclusions There is no difference in pain and functional outcome when treating lumbar radiculopathy with or without contrast using TFESI. The TFESI without contract technique has a shorter operation time and lower intra-operative fluoroscopic dosage without complications.

Keywords

• spinal stenosis
• injection
• radiculopathy
• contrast media