Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy.

BACKGROUND: The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis.

OBJECTIVE: To evaluate the effectiveness of fluoroscopically guided transforaminal epidural steroid injections as a conservative treatment for patients with degenerative lumbar scoliotic stenosis and radiculopathy.

DESIGN: Retrospective case series.

METHODS: The study was performed in an academic outpatient physical medicine and rehabilitation spine practice. Participants included 61 patients with radiographic evidence of degenerative lumbar scoliotic stenosis and radiculopathy. Patients who had undergone at least one fluoroscopic-guided transforaminal epidural steroid and anesthetic injection were included.

MAIN OUTCOME MEASURES: Numeric Rating Scale (NRS) for worst pain experienced, North American Spine Society (NASS) satisfaction scale, amount of pain medication used, and adapted Stucki questionnaire to assess function and pain status.

RESULTS: We obtained follow-up on 52 (85.2%) of 61 included patients. We defined a successful outcome as a patient who was both satisfied with his or her results and experienced at least a 2-points improvement in NRS, Summary Pain, and Summary Function scores. Using these criteria for success, 59.6% of our patients had a successful outcome at one week post-injection, 55.8% at one month post-injection, 37.2% at one year post-injection, and 27.3% had a successful outcome at two years post-injection (p < 0.01).

CONCLUSION: Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and radiculopathy and should be considered before surgical intervention.