Transforaminal epidural steroid injection for radiculopathy and the evolution to surgical treatment: a pragmatic prospective observational multicenter study

Abstract

Aim: The aim of this study is to analyze the real-world outcomes of transforaminal epidural steroid injections (TFESIs) in all patients with radiculopathy and their long-term outcomes. Methods: Patients with radiculopathy and failure of conservative treatment were included in a prospective, multicenter, observational cohort study. Results: In total, 117 patients were treated with one or two TFESIs. The mean duration of follow-up was 116 (±14) weeks. In total 19,6% (95% CI: 12.9–28.0%) patients were treated with surgery after insufficient symptom improvement. The evolution to surgery was not associated with etiology, symptom duration or previous spine surgery. Conclusion: Real-world data confirms that TFESIs is an effective treatment with satisfactory results in about 80% of patients for a period of 2 years.

Plain language summary

This study focusses on evaluating the real-world effectiveness of transforaminal epidural steroid injections (TFESIs) in treating radiculopathy, a condition characterized by back and leg pain due to compressed spinal nerves. This nerve compression can originate from different problems.

A total of 117 patients with radiating leg pain were included in this study. The infiltrations were administered, and the primary outcome was the need for spinal surgery within 2 years. The findings revealed that approximately 20% of patients eventually required surgery due to unsatisfactory results after injections. However, for patients with satisfactory outcomes, there was a notable reduction in back and leg pain, disability and pain medication usage, along with an improved quality of life.

Importantly, the results suggested that TFESIs could be considered as a treatment option in daily clinical practice, also after a prolonged duration of symptoms.

Despite certain limitations, such as the absence of a control group undergoing immediate surgical treatment, the real-world data supported the effectiveness of TFESIs in treating radiculopathy. This information provides valuable insights for spine surgeons and pain physicians in understanding the prognosis of TFESIs across diverse patient scenarios.

Tweetable abstract

The current real-world evidence shows that TFESIs are effective in about 80% of patients for a period of 2 years. The evolution to surgery seems not to be associated with etiology, symptom duration or previous spine surgery.

Summary points

• Lumbosacral radiculopathy is characterized by a radiating back and leg pain localized in the dermatome of a compressed spinal nerve.

• When conservative treatment fails, more invasive treatments such as transforaminal epidural steroid injections (TFESIs) are considered.

• TSESIs are a safe and effective treatment for lumbar radiculopathy.

• Data from real world practice, shows that after TFESIs, 19.6% of patients proceed to a surgical treatment over 2 years of follow-up.

• The evolution to surgery in independent from the etiology, symptom duration or previous surgery.

• In general, 43% of all patients were able to stop all pain medication after one or two TFESIs.

Keywords: :

• degenerative spinal disease
• lumbar disc herniation
• sciatica
• surgery
• transforaminal epidural steroid injections

Author contributions

All authors contributed to the study conception and design and data collection. Data analysis and interpretation were performed by V Raymaekers, M Plazier and DD Ridder. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Financial disclosure

This investigator-initiated study is part of a prospective big data collection in spinal pathology, supported by Medtronic Inc (grant number: NM-3422). Europe. Medtronic was not involved in the collection and analysis of the data, nor in writing the article. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they obtained verbal informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report, which was written afterwards on the Back-App for data collection.

Data sharing statement

The authors certify that this manuscript reports original clinical trial data. The data will not be made available.

Additional information

Funding

This investigator-initiated study is part of a prospective big data collection in spinal pathology, supported by Medtronic Inc (grant number: NM-3422).