Article
Results of transforaminal lumbar injection compared to other injection techniques in the interventional pain therapy of degenerative diseases of the lumbar spine
Ergebnisse der transforaminalen lumbalen Injektion im Vergleich gegenüber anderen Injektionstechniken in der interventionellen Schmerztherapie von degenerativen Erkrankungen der Lendenwirbelsäule
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Authors
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A. Lienert
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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S. Ruetten
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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P. Hahn
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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G. Godolias
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
| Published: | May 8, 2006 |
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Outline
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Objective: After conservative measures have been exhausted, interventional pain therapy may be indicated in degenerative diseases of the lumbar spine. Structures involved in the onset of pain are concentrated in the area of the intervertebral foramen. The objective of this prospective randomized study was to evaluate the transforaminale (TF) application of analgesic and antiphlogistic substances compared to transsacral (TS), dorsal (D) and dorsal-crossed (DC) techniques.
Methods: In 2003/2004, 4 groups of 50 patients each were treated. They were classified in 3 categories: Ischialgias with disc herniation (DH) or with spinal stenosis (SS), and back pain with disc degeneration (DD). After initial needle positioning without image control (TS, D, DC) image control was performed with contrast dye. 5 ml Bupivacain 0.5% and 10 mg Triamcinolonacetonide were applied. All patients had been conservatively treated previously as outpatients without epidural injections. Absolute indication for surgery was not present. In addition to general parameters , the following measuring instruments were used: VAS, German Version NASS, Oswestry-Questionnaire. Follow-up lasted for 18 months. 178 patients (89%) were followed.
Results: The following complications occurred: D=2x post-puncture headache, DC=1x post-puncture headache. Image control of the primary injection performed without image control revealed the following positioning errors: D=9x, DC=8x, TS=16x. The statistical assessment showed in all categories DH, SS and DD significantly better results in the Group TF. Within this group, there were no significant deviations. The results in Group DC were significantly better than in Groups D and TS. Results in Group D were significantly better than those in Group TS. Within Groups D and DC, there were significantly better results in category DH. The significantly worst results in category DD were found in Group TS.
Conclusions: The transforaminal technique shows better results in all categories in this study compared to transsacral, dorsal and dorsal-crossed techniques. Within the grading scheme in disc herniation and spinal stenosis, caudal and dorsal techniques are of value, since the apparative requirement is lower. Of these techniques, the dorsal-crossed technique produced the best results. The transforaminal technique should be preferred if the dorsal-crossed technique is unsuccessful, or in cases of back pain or appropriate symptoms.
