Outcomes of Patients with Degenerative Lumbar Spondylolisthesis Treated Using Transforaminal Epidural Steroid Injections
Introduction: This study involved a prospective cohort of patients with degenerative lumbar spondylolisthesis (DLS) who underwent fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI).
Purpose: The purpose of this study is to report the short- and long-term outcomes of fluoroscopically guided lumbar TFESI in a group of DLS patients.
TFESI has been widely used for the treatment of lumbosacral radicular pain. The procedure has the advantages of accuracy, specific targeting, and safety. However, to the knowledge of the researchers, a well-designed study to evaluate the outcomes of TFESI in patients with DLS is lacking.
Methods: Thirty-eight patients with DLS underwent fluoroscopically guided lumbar TFESI during April 2009 through March 2010. There were 13 men and 25 women; average age of 62 years.
Study participants met the following inclusion criteria: history of low back pain, unilateral radiating pain below the knee, DLS Grade 1 with one or two levels of neural compression on MRI, and failure of nonoperative treatment for at least six weeks. Exclusion criteria included prior lumbar surgery, pars defect(s), and previous epidural steroid injections.
Patients were divided into two groups of either one or two levels of spinal canal stenosis (SCS) found on MRI. Patients with single level SCS (n=24) received one level of TFESI, and those with two levels of SCS (n=9) received two levels of TFESI (80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride).
Each patient was independently observed pre-injection, and then at intervals of 2 and 6 weeks, and at 3 and 12 months after the injection(s). Outcome measures were the Roland 5-point pain scale, Visual Analogue Scale (VAS), standing and walking tolerance tests, and patient satisfaction.
Results: Data from 33 DLS study participants who completed at least a year of follow up was analyzed. The average number of injections per patient was 1.9. No major complications were reported.
- Roland 5-point and VAS scores were reduced in short- and long-term follow ups.
- Standing and walking tolerances were significantly improved only in the short-term, with no difference long-term.
- Patient satisfaction was highest at 2-weeks post-TFESI and declined thereafter.
Conclusion: Fluoroscopically guided lumbar TFESI demonstrated short- and long-term reduction in Roland-5 point and VAS scores, and short-term improvement in standing and walking tolerances. DLS patients with single-level SCS had better outcomes than patients with two-level SCS.
Kraiwattanapong C, Wechmongkolgorn S, Chatriyanuyok B, Woratanarat P, Udomsubpayakul U, Chanplakorn P, et al. Outcomes of Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spondylolisthesis Patients. Asian Spine J. 2014;8(2):119-128.
Kraiwattanapong, et al report the results of their study of 38 patients (13 men, 25 women) with degenerative lumbar spondylolisthesis treated using fluoroscopically guided transforaminal lumbar epidural steroid injections. The selection criteria were very stringent and included no previous lumbar surgery, and no structural pathologies except for a Grade 1 spondylolisthesis. There was a crossover of 4 patients who had surgery during the study period.
This study confirms that TFESI can be successful in relieving symptoms from lumbar stenosis associated with a Grade 1 degenerative spondylolisthesis. Although a two-year follow-up is laudable, it would have been interesting to see the results at longer follow-up. Furthermore, it would have been helpful if the study included a grading scale for the level(s) of stenosis presented in these patients, and whether or not the patient results could have been stratified based on that.