Publication:

A comparative study of efficacy between transforaminal epidural injection and selective nerve root block in disc prolapse of L4-L5 and L5-S1

Background To compare efficacy between transforaminal epidural injection (TFEI) and selective nerve root block (SNRB) in prolapsed L4-L5 and L5-S1 disc.

Methods This study was a randomized parallel group open label interventional study. Patients suffering from low back pain (LBP) with radiation due to prolapsed inter-vertebral disc (PIVD) were selected for intervention (n=78). After computer generated randomization, they were allocated into two groups (TFEI group and SNRB group) consisting 39 patients in each group. Each patient received combination of 2 ml of depot methylprednisolone acetate (40 mg/ml) and 1 ml of 0.25% preservative free bupivacaine under fluoroscopy guidance.                                                                                                            Primary outcome measures were visual analogue scale (VAS) score of LBP and VAS score of radiation pain. Secondary outcome measure was Oswestry LBP disability questionnaire (ODQ) score.

Results At 1-day post-intervention TFEI group showed statistically significant improvement in VAS score of LBP (p=0.000) as compared to SNRB group. At 1-month post-intervention TFEI group showed statistically significant improvement in VAS score of LBP (p=0.000) and VAS score of radiation pain (p=0.000) as compared to SNRB group. At 3-month post-intervention TFEI group again showed statistically significant improvement in VAS score of LBP (p=0.000), VAS score of radiation pain (p=0.000), and ODQ score (p=0.000) as compared to SNRB group.

Conclusions TFEI is better than SNRB in terms of improvement in LBP, radiation pain, and functional activity up to 3-month post-intervention.