A study of efficacy between interlaminar vs transforaminal approaches in symptomatic intervertebral disc herniations when treated with triamcinolone acetate

Dheeraj V. Kumar; Mithun Shetty; Bhaskar Bhandary; Manjunath S.

doi:10.51248/.v43i4.2482

Authors

Dheeraj V. Kumar
Mithun Shetty
Bhaskar Bhandary
Manjunath S. Junior resident

DOI:

https://doi.org/10.51248/.v43i4.2482

Keywords:

Disc prolapse, interlaminar, transforaminal, epidural steroid infiltration, IVDP

Abstract

Introduction and Aim: With lumbar disc herniations occurring in the population at a rate of 2-3%, low back pain is one of the most common chronic pain syndromes. Since 1952, patients with failed medical and conservative therapy for lumbar radiculopathy in presence or absence of discogenic back pain have been treated using epidural corticosteroid injections. Triamcinolone acetate, a local steroid, limits the inflammatory response. Interlaminar, transforaminal and caudal routes are various approaches for steroid injections. This study compared the effectiveness of triamcinolone acetate injections administered via an interlaminar vs. transforaminal method. The aim was to contrast the transforaminal technique and interlaminar approach to triamcinolone acetate's effectiveness in relieving pain.

Materials and Methods: In this study, 60 patients with low back pain are divided into two groups of 30 patients each and randomly allocated to receive care. Triamcinolone acetate solution, 40 mg, is used in each group. Interlaminar approach was chosen to inject the drug into the epidural space blindly, whereas through the transforaminal approach, the drug was delivered using dye with the help of fluoroscopic guidance. The outcome comprises evaluating pain reduction at the second and fourth weeks following the injection using a numerical scale and a verbal evaluation scale. Data was gathered after 15 minutes, at the 2^ndand 4^th week post injection.

Results: Patients who received triamcinolone acetate via transforaminal route experienced greater pain reduction in terms of NRS and VAS at the second week.

Conclusion: When comparing the NRS and VAS scores for pain alleviation, transforaminal is preferable to interlaminar because it delivers triamcinolone acetate to specific targets and is more successful than ILESI.

Author Biographies

Dheeraj V. Kumar

Department of Orthopaedics, A. J. Institute of Medical Sciences, Mangalore, 575004, Karnataka, India

Mithun Shetty

Department of Orthopaedics, A. J. Institute of Medical Sciences, Mangalore, 575004, Karnataka, India

Bhaskar Bhandary

Department of Orthopaedics, A. J. Institute of Medical Sciences, Mangalore, 575004, Karnataka, India

Manjunath S., Junior resident

Department of Orthopaedics, A. J. Institute of Medical Sciences, Mangalore, 575004, Karnataka, India

References

Divyasree, S., Kumaresan, A., Vishnuram, S. Effect of Mckenzie lumbar extension exercise with TENS on lumbar radiculopathy. Biomedicine. 2023 Jul 20;43(3):1032-1035.

Vialle, L.R., Vialle, E.N., Henao, J.E., Giraldo, G. Lumbar disc herniation. Revista Brasileira de Ortopedia (English Edition). 2010; 45(1):17-22.

Tachihara, H., Sekiguchi, M., Kikuchi, S.I., Konno, S.I. Do corticosteroids produce additional benefit in nerve root infiltration for lumbar disc herniation? Spine. 2008;33(7): 743-747.

DePalma, M.J., Bhargava, A., Slipman, C.W. A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Archives of Physical Medicine and Rehabilitation. 2005;86(7):1477-1483.

Fish, D.E., Lee, P.C., Marcus, D.B. The S1 “Scotty dog”: report of a technique for S1 nerve root block epidural steroid injection. Archives of Physical Medicine and Rehabilitation. 2007; 88(12):1730-1733.

Karppinen, J., Malmivaara, A., Kurunlahti, M., Kyllönen, E., Pienimäki, T., Nieminen, P., et al. Periradicular infiltration for sciatica: a randomized controlled trial. Spine. 2001;26(9): 1059-1067.

Kumar, N., Gowda, V. Cervical foraminal selective nerve root block: a ‘two-needle technique’ with results. European Spine Journal. 2008;17(4):576-584.

Ng, L., Chaudhary, N., Sell, P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine. 2005; 30(8):857-862.

Postacchini, F. Management of herniation of the lumbar disc. The Journal of Bone and Joint Surgery. British volume. 1999; 81(4):567-576.

Logisha, S. M., Nivetha, G., Mustafa, M. M., Siddiq, A. T., Muthukumar, N. J., Mahalakshmi, V. Comparison of different varmam approaches by varmam practitioners of various places in Tamil Nadu in the treatment of thandaga vadham (lumbar spondylosis). Biomedicine. 2023 Apr 9;43(01):521-524.

Sayegh, F.E., Kenanidis, E.I., Papavasiliou, K.A., Potoupnis, M.E., Kirkos, J.M., Kapetanos, G.A. Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine. 2009; 34(14):1441-1447.

Schaufele, M.K., Hatch, L., Jones, W. Interlaminar versus nerve root block epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician. 2006; 9(4):361.

Divyashri, S., Prathap, L., Preetha, S. Association of lumbar spine mobility and hamstring tightness in dental practitioners. Biomedicine. 2021 Apr 3;41(1):146-149.

Park, C.H., Lee, S.H., Kim, B.I. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Medicine. 2010;11(11):1654-1658.

Abdi, S., Datta, S., Lucas, L.F. Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005; 8(1):127-143.

Abdi, S., Datta, S., Trescot, A.M., Schultz, D.M., Adlaka, R., Atluri, S.L., et al., Epidural steroids in the management of chronic spinal pain: a systematic review. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.2007;10;185-212.

Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. The Orthopedic clinics of North America. 1991 Apr 1;22(2):181-187.

Gharibo, C.G., Varlotta, G.P., Rhame, E.E., Liu, E.C., Bendo, J.A., Perloff, M.D. Interlaminar versus nerve root block epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study. Pain Physician. 2011; 14(6):499-511.

Kolsi, I., Delecrin, J., Berthelot, J.M., Thomas, L., Prost, A., Maugars, Y. Efficacy of nerve root versus interspinous injections of glucocorticoids in the treatment of disk-related sciatica. A pilot, prospective, randomized double-blind study. Joint Bone Spine. 2000; 67(2):113-118.

Lee, J.H., Moon, J., Lee, S.H. Comparison of effectiveness according to different approaches of epidural steroid injection in lumbosacral herniated disk and spinal stenosis. Journal of Back and Musculoskeletal Rehabilitation. 2009; 22(2):83-89.

Ackerman, W.E., Ahmad, M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesthesia and Analgesia. 2007; 104(5):1217-1222.

Yilmaz, Y., Kaya, M. Risk factors for low back pain and its relation with pain related disability and depression in a Turkish sample. Turkish neurosurgery. 2009; 19(4):327-332.

Hopwood, M. B., Abram, S.E. Factors associated with failure of lumbar epidural steroids. Regional Anesthesia and Pain Medicine. 1993 Jul 1;18(4):238-243.