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Comparison of the Oblique Interlaminar and Transforaminal Lumbar Epidural Steroid Injections for Treatment of Low Back and Lumbosacral Radicular Pain

Authors Choi EJ, Park SJ, Yoo YM, Yoon JU, Shin SW, Byeon GJ

Received 20 November 2020

Accepted for publication 27 January 2021

Published 15 February 2021 Volume 2021:14 Pages 407—414


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Michael Schatman

Eun-Ji Choi,1,2 Soon Ji Park,1 Yeong-Min Yoo,1 Ji-Uk Yoon,1,2 Sang-Wook Shin,1,2 Gyeong-Jo Byeon1,2

1Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea; 2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

Correspondence: Gyeong-Jo Byeon
Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
Tel +82-55-360-2129
Fax +82-55-360-2149

Background: Transforaminal epidural steroid injections (TF-ESIs) effectively deliver small amounts of drugs to inflamed sites via the ventral epidural space. However, there is a high risk of nerve damage as the needle narrowly approaches the spinal nerve. Therefore, we devised an oblique interlaminar (OIL) approach as an alternative method. We compared the efficacy of fluoroscopic-guided OIL-ESIs with that of TF-ESIs in the management of lower back and unilateral lumbosacral radicular pain.
Materials and Methods: Sixty-six patients were randomized to receive a fluoroscopic-guided ESI either through the OIL (n = 33, group OIL) or TF (n = 33, group TF) approach. They were evaluated for effective pain relief using the visual analogue scale (VAS) and for functional improvement using the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ). Other outcome measures were the presence of ventral and contralateral spread of contrast, patients’ satisfaction, and adverse events.
Results: There were no significant differences between the groups in the VAS, ODI, and RMDQ scores during the 12-week period. The differences in the ODI and RMDQ scores before and after the treatment were higher in group TF than in group OIL. The contralateral spread of contrast was higher in group OIL than in group TF. There were no significant differences in the other outcomes between the groups.
Conclusion: ESIs delivered through the OIL approach are equally effective in pain relief and functional improvement as those delivered via the TF approach in the management of low back and unilateral lumbosacral radicular pain.

Keywords: epidural analgesia, fluoroscopy, low back pain, radicular pain, steroid injection

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