Who Benefits From Lumbar Steroid Injections?

Joseph K. Lee, MD

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Posted: 08/24/2011

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Predictors of a Favorable Response to Transforaminal Injection of Steroids in Patients With Lumbar Radicular Pain Due to Disc Herniation

Ghahreman A, Bogduk N
Pain Med. 2011;12:871-879

Study Summary

Lumbar transforaminal epidural steroid injections (TF-ESIs) are a common type of treatment for radicular pain caused by a disc herniation. Predictors of favorable response (> 50% pain reduction beyond the first month of treatment), however, have not been well delineated in the literature.

Ghahreman and Bogduk examined 71 patients who were treated with a lumbar TF-ESI due to a disc herniation.^[1]Radiologic review of MRI imaging revealed an inverse relationship between severity of nerve compression and response to a TF-ESI. Favorable response to a lumbar TF-ESI was seen in 75% of patients with low-grade nerve compression and in only 26% of patients with high-grade nerve compression. No association was seen with factors such as location, morphology, or size of disc herniation. Clinical features, such as duration of symptoms, sensory abnormalities, and presence of neurologic changes did not predict a favorable response either.

Viewpoint

Lumbar TF-ESIs are routinely used as nonsurgical treatment for radicular lumbar pain caused by a disc herniation. This is the first such article to evaluate factors that can predict clinical response to single level lumbar TF-ESIs. From these results, gradation of nerve compression severity theoretically becomes a pertinent part in determining the potential success and limitations of such treatments.

Radiologic severity of nerve compression alone, however, may not fully explain or predict treatment response. Degenerative stenosis showing similar degrees of nerve compression by the same thought process should also give clinically similar symptoms, but it is often asymptomatic. Furthermore, in many cases, clinical and radiologic films may indicate potential involvement of more than one nerve level. Future comparative studies focused on additional predictive factors may provide more answers to such questions.

Abstract

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