Comparison of effectiveness according to different approaches of epidural steroid injection in lumbosacral herniated disk and spinal stenosis

Purpose: This study was to compare the effectiveness of the translaminar, caudal, and transforaminal technique with small and large volume of injectate in the treatment of lumbosacral herniation of intervetebral disc (HIVD) or spinal stenosis (SS). Method: Medical records reviewed retrospectively were of patients with radicular pain over 3 months and had diagnosed as HIVD or SS. Patients who underwent four weeks of treatments such as analgesics, anti-inflammatory drugs, or physical therapy for radicular pain with no improvement and afterwards received ESI were selected. Exclusion criteria was those who had suffered trauma, patients with other serious diseases, patients demonstrating adverse reactions to the medications, and patients with more than two levels of disease. The number of HIVD and SS group is 95 and 138, respectively. Visual Analog Scale (VAS) pain score, Patient Satisfaction Index (PSI), and Roland 5-point pain score were compared between different epidural approaches at pretreatment, 2 weeks, 1 month, and 2 months after treatment. Results: Higher ratio of successful results was found in translaminar and transforaminal techniques than caudal technique in VAS in the HIVD group and in VAS and PSI in the SS group. Reduction of Roland score was maintained until 2 months in all techniques in HIVD and SS groups. In SS group, transforaminal groups showed more reduction of Roland score than caudal approach. No difference was found between small and large volume of transforaminal techniques. Conclusion: Translaminar and transforaminal approach were more effective than caudal approach in HIVD and SS groups. Especially, effectiveness of transforaminal approach was more prominent in SS group as compared with HIVD group.