An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

Leon Neve¹, John Orchard², Nathan Gibbs³, Willem van Mechelen⁴, Evert Verhagen⁴, Ken Sesel⁵, Ian Burgess⁶, Brett Hines^6
1VU University, Amsterdam, The Netherlands; ²School of Public Health, University of Sydney, Sydney, NSW, Australia; ³South Sydney Sports Medicine, Sydney, NSW, Australia; ⁴EMGO, VU University, Amsterdam, The Netherlands; ⁵Sydney X-ray Centre, Sydney, NSW, Australia; ⁶Mater Imaging, Sydney, NSW, Australia

Background: Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2). These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI) or computed tomography (CT), even though this treatment scenario has not been adequately studied for this last diagnosis.
Objectives: To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain.
Study design: Retrospective case series.
Methods: Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N.
Results: 153 patients were eligible for the study (Group D: 93/Group N: 60). Eventually 110 patients responded (Group D: 67/Group N: 43). Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the long term. A larger proportion however, indicated that the injection had certainly improved their symptoms in the short term, but noted that the effects were non-lasting (Group D: 28%/Group N: 30%). Two patients were certain the injections had actually worsened their symptoms. No significant differences in characteristics and outcomes between Group D and Group N were noted.
Conclusions: Outcomes of this study suggest fluoroscopically guided lumbar cortisone injections may have similar outcomes in patients with non-specific exercise-related lower-limb pain compared to patients with disc prolapse proven on MRI or CT causing back-related lower-limb pain. This might suggest a potential role for these injections in the treatment of non-specific exercise-related lower-limb pain. It should be noted that this is a low level of evidence study (level 3) and further study is warranted.

Keywords: back-related lower-limb pain, fluoroscopically guided cortisone injections