Document Detail


Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series.
MedLine Citation:
PMID:  23351495     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery.
METHODS: We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers' compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery.
RESULTS: We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers' compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI.
CONCLUSION: Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.
Authors:
Neil A Manson; Melissa D McKeon; Edward P Abraham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  56     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-22     Completed Date:  2013-05-16     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  89-96     Citation Subset:  IM    
Affiliation:
The Canada East Spine Centre, Saint John Regional Hospital, Saint John, NB. Neil.Manson@HorizonNB.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Glucocorticoids / administration & dosage*
Humans
Injections, Epidural
Intervertebral Disc Displacement / complications,  drug therapy*,  surgery
Magnetic Resonance Imaging
Male
Middle Aged
Radiculopathy / etiology
Radiography, Interventional
Retrospective Studies
Sciatica / etiology
Treatment Outcome
Triamcinolone / administration & dosage*
Chemical
Reg. No./Substance:
0/Glucocorticoids; 124-94-7/Triamcinolone
Comments/Corrections

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