Article

As our population ages, neurogenic claudication (NC) from central
canal stenosis of the lumbar spine is becoming an increasingly common condition.
Studies have been undertaken to assess the efficacy of caudal, interlaminar, or
unilateral transforaminal epidural injections, but bilateral transforaminal
epidural injections (BTESIs) have not been evaluated to date. OBJECTIVE: To
assess the therapeutic value and long-term effects of fluoroscope-guided BTESIs
in patients with NC from degenerative lumbar spinal stenosis (DLSS) of the
central spinal canal. DESIGN: Case series. SETTING: Single institution spine
clinic. PATIENTS: Twenty-six adults between the ages of 40 and 90 years with a
diagnosis of DLSS and a history of subacute or chronic NC. METHODS/INTERVENTIONS:
Patients meeting inclusion criteria received fluoroscope-guided BTESI of local
anesthetic and steroid at the level immediately below the most stenotic level.
Patient self-reported pain level, activity level, and overall satisfaction were
recorded by telephone interview at 1, 3, and 6 months after injection by an
independent observer. MAIN OUTCOME MEASURES: Pain score and Swiss Spinal Stenosis
score at baseline, 1, 3, and 6 months. RESULTS: Of the 22 participants eligible
for analysis, 20, 19, and 18 had follow-up data available at 1, 3, and 6 months,
respectively. Reduction in numeric pain scale score of at least 50% was noted in
30% of participants at 1 month, 53% at 3 months, and 44% at 6 months. Swiss
Spinal Stenosis subscale scores indicated a significant reduction in the
proportion of participants reporting the presence of severe pain in the back,
buttocks, and legs (particularly the back or buttocks) at 1, 3, and 6 months of
follow-up compared with baseline (P < .05). The proportion of participants
reporting severe weakness in the legs or feet also decreased after injection and
was statistically significant at 3 months of follow-up (P = .04). CONCLUSIONS:
Fluoroscope-guided BTESI was moderately effective in reducing pain, improving
function, and achieving patient satisfaction in patients with NC from DLSS at the
central spinal canal in this clinical case series. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS