Assessment of Efficacy of Transforaminal Epidural Steroid Injection for Management of Low Back Pain with Unilateral Radiculopathy in Industrial Workers: A Randomized Control Trial

Abstract

Introduction: Disability related to chronic Low Back Pain (LBP) is a multi-factorial phenomenon, associated with high social and health costs, with a prevalence ranging from 11 to 76%. Significant and long-lasting pain relief can be achieved with transforaminal epidural steroid injection. Surgery is indicated for those patients with progressive neurological deficits or severe LBP refractory to conservative measures. Aim: To evaluate the efficacy of transforaminal epidural steroid injection through pelvic angle measurement, pain and disability measurements in patients with LBP and radiculopathy. Materials and Methods: This prospective randomized controlled study was conducted in Department of Pain in ESI institute of pain management for the industrial workers at Kolkata, India between October 2015 and September 2016. Sixty patients aged between 18 to 60 years, who attended pain clinic with complaints of LBP with unilateral radiculopathy due to lumber disc herniation were included in this trial. Patients were divided into 2 groups (30 patients in each group); Group I: Test group received single transforaminal epidural steroid injection with deposteroid (20 mg) and 0.25% bupivacaine (total 2 ml) together with oral medications and exercises at day 0. Group II: Control group received only medications and exercises on day 0/visit 1. Each patient was followed up for one month at visit 2. Each patient was assessed with Numeric Rating Scale (NRS) for pain intensity and modified Oswestry Disability Index (ODI) for measurement for disability and pelvic angle measurement on affected side. Results: During study period, 60 confirmed patients were included in the analysis. NRS for pain intensity measurement between visit 1(V1) and 2 (V2), showed significant improvement (p-value is < 0.001) in group I. ODI scores between 2 visits showed better outcome in group I. Pelvic angle measurement of affected limb on second visit in both groups as compared to first visit, showed significant improvement, but changes are more evident in group I than group II. Conclusion: Transforaminal epidural injection not only decreases pain and disability due to pain significantly but also decreases pelvic angulations significantly after one month in lumber disc herniation with unilateral radiculopathy.

Keywords

• Disability
• Exercise
• Lumber disc herniation
• Pelvic angle measurement