Comparison of the Efficacy of Lumbar Transforaminal Epidural Steroid Injections according to Its Approach Techniques : One Level Versus Two Level Method

Abstract

The present study was undertaken to compare the effectiveness of transforaminal epidural steroid injection (TFESI) for sciatica by its technique, one level vs. two level method and to identify other possible outcome predictors. Transforaminal epidural steroid injections were performed in 150 patients from August 2006 to March 2007. Seventy-five patients (35 women, 40 men; mean age, 62.8 years) who meet the inclusion criteria were studied. Therapeutic effects were evaluated 2 weeks after injection. The possible outcome predictors were as follows: one level vs. two level injection, Beck Depression Inventory scores (<13, 14-19, >20), Beck Anxiety Inventory scores (<7, 8-15, >16), cause of radiculopathy (spinal stenosis vs herniated disk), gender, duration of radiculopathy (<6 months, 6-12 months, >6 months), Oswestry Disability Index scores (<30, 31-60, >60). The relationships between possible outcome predictors and therapeutic effects were evaluated. Forty-nine (65.3%) of the 75 patients achieved a satisfactory result 2 weeks after transforaminal epidural steroid injection. Twenty-four (52.2%) of the 46 patients treated by a one level injection and 25 (89.3%) of the 28 patients treated by a two level injection showed a satisfactory result, and this outcome was significantly different (p<0.01). Other possible outcome predictors did not show any statistical difference. Transforaminal epidural steroid injection is an effective way for managing radiculopathy, and a two level injection may be a predictor of a better outcome.

경추간공 경막외 스테로이드 주입(Transforaminal Epidural Steroid Injections, TFESI)은 요척주관 협착증이나 추간판 탈출증에 의한 요하지통을 치료하기 위한 효과적인 방법이다. 본 연구는 TFESI를 하는 기술적인 방법(한 레벨 혹은 두 레벨)에 따른 유용성의 차이를 비교하고 그 외의 치료 결과의 예측 인자들을 알아보기 위해 시행하였다. 연구 기준을 만족하는 요척주관 협착증 혹은 추간판 탈출증 환자 75명을 대상으로 하였으며 46명은 한 레벨의 TFESI(고식적인 방법)를, 29명은 두 레벨의 TFESI(고식적인 방법+전신경절 방법)를 시행받았다. TFESI 2 주후 전체 75명중 49명에서(65.3%) 만족스러운 결과를 나타내었다. 한 레벨의 TFESI는 52.2%에서, 두 레벨의 TFESI는 89.3%에서 훌륭한 치료 결과를 나타냈고 이것은 통계적으로 유의한 차이를 보였다. 그 외 BDI, BAI, 요하지통의 원인, 통증 기간, 성별, 나이, ODI 등에 따른 치료 결과의 차이는 없었다.