A study of efficacy between interlaminar vs transforaminal approaches in symptomatic intervertebral disc herniations when treated with triamcinolone acetate

Abstract

Introduction and Aim: With lumbar disc herniations occurring in the population at a rate of 2-3%, low back pain is one of the most common chronic pain syndromes. Since 1952, patients with failed medical and conservative therapy for lumbar radiculopathy in presence or absence of discogenic back pain have been treated using epidural corticosteroid injections. Triamcinolone acetate, a local steroid, limits the inflammatory response. Interlaminar, transforaminal and caudal routes are various approaches for steroid injections. This study compared the effectiveness of triamcinolone acetate injections administered via an interlaminar vs. transforaminal method. The aim was to contrast the transforaminal technique and interlaminar approach to triamcinolone acetate's effectiveness in relieving pain. Materials and Methods: In this study, 60 patients with low back pain are divided into two groups of 30 patients each and randomly allocated to receive care. Triamcinolone acetate solution, 40 mg, is used in each group. Interlaminar approach was chosen to inject the drug into the epidural space blindly, whereas through the transforaminal approach, the drug was delivered using dye with the help of fluoroscopic guidance. The outcome comprises evaluating pain reduction at the second and fourth weeks following the injection using a numerical scale and a verbal evaluation scale. Data was gathered after 15 minutes, at the 2nd and 4th week post injection. Results: Patients who received triamcinolone acetate via transforaminal route experienced greater pain reduction in terms of NRS and VAS at the second week. Conclusion: When comparing the NRS and VAS scores for pain alleviation, transforaminal is preferable to interlaminar because it delivers triamcinolone acetate to specific targets and is more successful than ILESI.