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BackgroundRadicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons.ObjectiveOur study aimed to assess the outcomes of pulsed readiofrequency treatment (PRF) according to electrodiagnosis results in patients with chronic intractable lumbosacral radicular pain.MethodsA total of 82 failed back surgery syndrome (FBSS) patients were included in this study. All of them underwent electromyography/nerve conduction studies before pulsed radiofrequency (PRF) treatment at the DRG, and they were classified according to the electrodiagnostic results as: group 1, no definite finding (normal); group 2, radiculopathy; and group 3, neuropathy. Pain intensity was assessed according to a numeric rating scale score and the Oswestry Disability Index (ODI) before treatment and at one, three, six, and 12 months after treatment, and successful treatment was defined as a pain score reduction of ≥50% at 12 months, as compared with the pretreatment score.ResultsPretreatment electrodiagnosis identified 28 patients with no definite findings, 31 patients with radiculopathy, and 23 patients with neuropathy. The patients with neuropathy had less pain relief after treatment than those with no definite findings and those with radiculopathy. The prevalence of pain reduction of at least 50% was lower in the neuropathy group than in the other groups. There was no statistically significant difference in ODI between group.ConclusionOutcomes after PRF at the DRG did not show strong differences according to electrodiagnostic findings in FBSS patients with chronic intractable lumbosacral radicular pain.

Objective Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that causes mechanical compression of the spinal nerve roots. The compression of these nerve roots can cause leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with LSS. The aim of our study was to determine the relationship between the severity of LSS using a grading system (grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; grade 3 = severe stenosis with none of the cauda equina separated) and the subject's response to computed tomography-guided lumbar epidural steroid injection (CTG-LESI) and to evaluate the short-term effectiveness. Methods Forty-seven consecutive patients with degenerative LSS were enrolled in this prospective study. All subjects underwent lumbar spine magnetic resonance imaging. Two radiologists independently graded lumbar central canal stenosis based on T2-weighted axial images. All CTG-LESI were performed in the procedure room. Outcome measures were obtained using the 5-point patient's satisfaction scale at 2 and 8 weeks post-treatment. To evaluate the outcome, we divided the patients into two groups according to their response to the treatment. Results Improvement (including reports of slightly improved, much improved, and no pain) was observed in 37 patients (78.7%) at 2 weeks and 36 patients (77.6%) at 8 weeks after the procedure. There was no statistically significant correlation between pain relief and age. Conclusions The grade of LSS appears to have no effect on the degree of pain relief associated with CTG-LESI. However, CTG-LESI seems to provide effective short-term pain relief due to LSS.

Objective. Lumbar transforaminal epidural steroid injections are procedures often utilized in the treatment of low back pain associated with radicular pain. Particulate steroids have been known to play a role in embolism. It is, unknown whether nonparticulate steroids are as effective as particulate steroids. To investigate the effect of an epidural steroid injection on back pain, we conducted a randomized, controlled trial comparing nonparticulate steroid with particulate steroid to treat lumbar disc herniation. Design. One hundred-six patients were randomized to receive lumbar transforaminal epidural steroid injections (N = 53) with either dexamethasone 7.5 mg, or with triamcinolone acetate 40 mg (N = 53). Measurement were taken before treatment and one month after treatment using a visual analog scale, short McGill pain questionnaire, and revised Oswertry Back Disability Index. Results. There was a statistically significant difference in the visual analog score between those treated with dexamethasone and those given triamcinolone. The two groups did not differ significantly on the McGill Pain Questionnaire, or the Oswestry Disability Index before and after treatment. Conclusion. In this study, dexamethasone and triamcinolone treatments were shown to have different effects on low back pain with sciatica, with triamcinolone being more effective than dexamethsone in lumbar radiculopathy.

Dear Editor, We present a case of successful treatment of post-dural puncture headache (PDPH) using a lumbar transforaminal epidural blood patch (TFEBP). Although epidural steroid injections are frequently used to manage lumbar spinal pain, a number of complications may arise ⇓. Among complications, PDPH is a painful one. The incidence of dural puncture ranges from 0.16–1.3%, but PDPH develops in 16–86% of patients after attempted epidural block with large-bore needles ⇓. A lumbar transforaminal epidural steroid injection (TFESI) may pose less risk than interlaminar injections ⇓ but still not free of minor complications ⇓. Treatment of PDPH varies. Standard conservative therapy (bed rest, oral hydration, increased salt intake) is appropriate initially, and other innocuous remedies (intravenous fluid, caffeine, and the use of abdominal truss) have been suggested ⇓. However, when conservative therapy fails, epidural blood patch (EBP) is a reasonable alternative. Generally, EBP calls for interlaminar approach, with injection of sterile autologous blood (10–30 mL) into epidural space ⇓. In our patient, PDPH occurred subsequent to lumbar TFESI and was successfully …

Background. Spinal stenosis is characterized by narrowing of the spinal canal, with mechanical compression of spinal nerve roots. The latter may cause low back pain and/or leg pain, as well as neurogenic claudication. Epidural steroid injection is commonly used to treat patients with lumbar spinal stenosis (LSS), but percutaneous epidural adhesiolysis has been utilized when symptoms prove refractory. Our goal was to assess the relationship between improvement shown on epidurogram and subjective patient response to adhesiolysis. Methods. For this prospective study, 78 patients with degenerative LSS were enrolled. Each subject underwent magnetic resonance imaging of the lumbar spine, with all therapeutic procedures conducted in the operating room. Two weeks later, a second epidurography was performed. Second epidurography was conducted to assess any change in epidural filling defects. Outcome measures were obtained using the visual analogue scale (VAS) score at two weeks, one month, and three months post-treatment. Results. All of the 78 study participants (mean age = 60.9 years, range = 34–85 years) displayed epidural filling defects at baseline. After percutaneous adhesiolysis, epidurographic filling defects were absent in 73% of patients. In the presence or absence of filling defects, mean VAS scores were 5.2 and 4.5, respectively, at two weeks’ follow-up. No significant correlation between postprocedural VAS score and status of filling defects (yes or no) was evident during the three-month follow-up period. Conclusion. In patients with LSS, eidurographic findings following percutaneous epidural adhesiolysis failed to correlate with level of pain reduction achieved.

Dear Editor, We appreciate the letter to the editor by Dr. Collighan, who mentioned that nonparticulate steroids had better mean pain relief, but there was no statistically significant difference between either one of the groups' degrees of pain relief. The improvement in activities exhibits a positive Pearson correlation in both particulate and nonparticulate steroids, but the correlation …