1. 2011;14;353-360Lumbar Retrodiscal Versus Post-Ganglionic Transforaminal Epidural Steroid Injection for the Treatment of Lumbar Intervertebral Disc Herniations
   Case Control Study
   Sang-Ho Lee, MD, PhD, Chan Hong Park, MD, PhD, and Hahck Soo Park, MD, PhD.

BACKGROUND: Lumbar transforaminal epidural steroid injections (TFESIs) are procedures often utilized in the treatment of radicular pain. TFESIs with a preganglionic approach have been reported to be more effective than TFESIs performed using a classic approach. However, it is unknown whether TFESIs using a retrodiscal approach are as effective as other approaches.

OBJECTIVE: To investigate the effect of an epidural steroid injection (ESI) on radicular pain, we conducted a randomized, controlled trial comparing a retrodiscal approach with a classic approach to treat lumbar disc herniation.

DESIGN: A case control study.

METHODS: Forty patients were randomized to receive lumbar TFESIs with either a retrodiscal approach (n=20) or with a classic approach (n=20). Measurements were taken before as well as 4 and 8 weeks after treatment using a visual analog scale (VAS) score, Patient Satisfaction Index (PSI) and the Roland 5-point pain score.

RESULTS: In the retrodiscal group, there was a statistically significant improvement in the VAS score after injection compared to baseline. In the classic group, there was a statistically significant improvement in the VAS score after injection compared to baseline. There was no statistically significant difference in the VAS score, PSI, or the Roland 5-point pain score between those treated with a retrodiscal approache and those treated with a classic approach.

LIMITATIONS: Secondary outcomes were not measured and the study did not include a mid- or long-term follow-up period.

CONCLUSION: In this study, TFESIs performed using a retrodiscal or classic approach had  similar effects on radicular pain. The classic and the retrodiscal transforaminal steroid injection resulted in equivalent pain relief.