Article

OBJECTIVE: To assess the relationship between epidural contrast dispersal
patterns from lumbar transforaminal epidural steroid injections (TFESIs) and both
immediate- and short-term pain reduction. We also investigated the effect of the
grade of nerve root compression on contrast dispersal pattern and pain reduction.
DESIGN: Retrospective review of data from a previous prospective study of
outcomes after TFESI. SETTING: Academic spine and musculoskeletal clinic. PATIENT
SAMPLE: Thirty-eight subjects who underwent single-level lumbar TFESI for
unilateral lumbar radicular pain. METHODS: A retrospective assessment of a
digital database of TFESIs for unilateral lumbar radicular pain. Type of contrast
pattern was analyzed by 2 physiatrists as type I (tubular appearance); type II
(nerve root visible as a filling defect); or type III (cloudlike appearance).
Grade of nerve root compression on magnetic resonance also was analyzed by 2
physiatrists as grade I abutment, grade II displacement, or grade III entrapment.
OUTCOME MEASURES: Effect of type of contrast pattern and grade of nerve root
compression on change in Numeric Pain Rating Scale (NPRS) at time of injection
(T1), 2 weeks after (T2), and 2 months after (T3). RESULTS: Mean decrease in NPRS
at all time points was statistically significant with both types I and III
contrast dispersal patterns. Groups with grades II and III nerve root compression
had statistically significant reductions in NPRS at all time points. CONCLUSIONS:
In this retrospective review we found that TFESIs can have an immediate
beneficial effect on pain regardless of contrast pattern type or grade of nerve
root compression. Subjects with higher grades of nerve root compression and a
type I or III contrast pattern have significantly greater reductions in pain at
15 minutes, 2 weeks, and 2 months. Our findings are limited by methodological
restrictions, and further confirmation with a prospective trial to review other
possible associated factors is recommended.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS