Comparing the clinical efficacy of preganglionic and preganglionic plus ganglionic transforaminal epidural steroid injections for lumbosacral radicular pain.

Abstract

Objectives: To compare the effectiveness of preganglionic transforaminal epidural steroid injection (TFESI) with preganglionic plus postganglionic TFESI.

Methods: Patients with unilateral radicular pain and disc pathology were randomly assigned to either the preganglionic group or the preganglionic plus postganglionic group. All patients were evaluated using a numeric rating scale (NRS) and a patient satisfaction scale (PSS) at the third week and the third month after treatment.

Results: There were significant differences between the patients' NRS scores after TFESI for both groups. In terms of >50% pain relief at three weeks and 3 months post-treatment, no significant differences were found between the groups (p>0.05). The PSS scores of the preganglionic plus postganglionic group were significantly lower at third month than at the third week (p=0.046). The PSS scores of the two groups were similar at third week and third month (p>0.05). A weak negative correlation was found between age and meaningful pain relief at the third month (Rho=.278, p=0.024). A moderate positive correlation was found between meaningful pain relief at the third week and meaningful pain relief the third month (Rho=.465, p<0.001). Male gender showed a weak positive correlation with meaningful pain relief at the third week (Rho=.281, p=0.022) and the third month (Rho=.256, p=0.038) CONCLUSION: The combined preganglionic plus postganglionic approach for TFESI did not affect the outcomes in patients with unilateral discogenic radicular pain. The preganglionic TFESI approach alone at the disc level was sufficient to achieve pain relief.