CT-guided transforaminal epidural steroid injection and vertebral axial decompression in management of acute lumbar disc herniation

Aim of the work: To assess the efficacy of CT-guided transforaminal epidural steroid injection (CT-TFESI) as compared to vertebral axial decompression (VAX-D), the combined effect of both and medical treatment in the management of acute lumbar disc herniation. Patients and methods: Forty-eight patients complaining of low back pain (LBP) with radicular symptoms due to lumbar disc herniation (<6 weeks duration) were enrolled. Patients were divided into 4 groups (12 patients each) and treated for one month; group I received three CT-TFESIs at 10 day intervals; group II received VAX-D sessions every other day; group III received three CT-TFESIs with simultaneous VAX-D sessions and group IV only received medical treatment. Evaluation of LBP intensity and its impact on activities of daily living was done using the Pain Visual Analogue Scale and the Oswestry Disability Index respectively at baseline, after 1 and 3 months from baseline. Results: Patients were 36 males and 12 females; their mean age was 38.6 +/- 3.07 years, disease duration was 14.23 +/- 6.51 days and body mass index was 44.9 +/- 7.1. Patients who received CT-TFESIs had 87.8% improvement in pain intensity and 45.5% functional improvement. Patients who had combined CT-TFESIs and VAX-D sessions had the highest functional improvement (79.8%) after 3 months with significant pain control (77.5%), especially in patients with shorter disease duration. Medical treatment was the least effective. Conclusion: All treatment modalities showed a significant improvement in pain and function, however, the combined CT-TFESIs with regular VAX-D sessions was the most effective. Further studies with a larger sample size and a longer follow up are needed to support our findings. (C) 2017 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.