European Journal of Molecular & Clinical Medicine

Aims and objective: To compare efficacy of pain relief function of therapeutic transforaminal vs interlaminar epidural steroid injections and to assess improvement in functional outcome in lumbar disc disease patients after treatment.
Methodology: Patients with back pain documented with lumbar disc disease treated initially with rest, analgesics and physiotherapy for 6 weeks, will be analyzed clinically and radiologically. All the patients selected for the study be examined according to protocol, clinical and radiological investigations. Patients will be subjected into two groups by simple random sampling containing 30 members each. Group A will be given transforaminal epidural steroid injection and Group B will be given epidural steroid injection by Interlaminar route. Post epidural steroid injection  patients were followed up for 6months and post injection disability and pain was assessed using Roland morris low back pain disability questionnaire, visual numerical score, finger floor distance, patient satisfaction score.
Results: Pre procedure Roland Morris Disability mean score was compared with post epidural steroid injection. Reduction of 5 score or more after procedure considered significant. In a group receiving transforaminal epidural steroid, among 30 patients 24 patients had relief at end of 1month, 16 patients had relief at end of 6 months, and in other group receiving epidural steroid through interlaminar technique in that 12 patients had significant relief at 1 month, 8 patients had significant relief at the end of 6 months. On comparison of both the groups Roland morris disability mean score was statistically significance at 1month, 3 months and 6 months  in  TFESI group compared to ILESI group (p<0.05). On comparison of pre and post procedure Finger floor distance  of both the groups it was significant in TFESI group compared to ILESI group at 1 month and 3 months (p<0.05)  and was not significant at 6 months. Comparison by Patient satisfaction group was significant at 3 months in TFESI group compared to ILESI group (p<0.05)  and was not significant at 1month and 6 months. On comparison by Visual numerical score both the groups did not show any statistical significance.  Post procedure the complications, such as dural puncture, excessive bleeding or infection were not reported in both groups. But headache was reported in 2 patients in ILESI.
Conclusion: Patients with radicular pain from disc herniation or lumbar canal stenosis obtain significant relief from a TFESI. Transforaminal epidural steroid therapy has better outcome with respect to Roland Morris disability assessment, Visual Numeric Scale, Finger Floor Distance. Patient Satisfaction and Pain Relief - majority of the patients have a significant improvement which lasts for 6 months.

Pain is the most common complaint. Axial back pain is typically present, although some patients do not have this complaint. Radicular pain is more typical and often the more “treatable” ofthe complaints. The pattern of lower extremity radiation depends on the level of the herniation. Lower lumbar or lumbosacral disc herniations can lead to the classic symptoms of pain radiating below the knee. Often pain extends into the foot and can follow a dermatomal distribution. S1 radicular pain may radiate to the back of the calf or the lateral aspect or sole of the foot. L5 radicular pain can lead to symptoms on the dorsum of the foot. Adult patients of either sex with intervertebral disc prolapse with or without neurological deficit, visiting or admitted were taken into the study. Patients with cauda equina syndrome were excluded from study. A total of 160 patients were included in the study. Patients with signs and symptoms of disc prolapse and who come under the inclusion criteria and give informed written consent were selected. Majority of our patients have disc prolapse at more than one level (65%) i.e. disc prolapse involving combination of L4-L5 & L5-S1, L3-L4 & L5-S1 etc. and others have disc prolapse at L4-L5 (23.1%) and L5-S1 (11.9%). No patients had disc prolapse at only level L1-L2, L2-L3 and L3-L4. There is no significant difference in distribution between the groups with respect to level of disc prolapse. (p=0.421).
 

A 30-year-old male with a 4-year history of chronic back pain complained of recent episodes of sharp mid back pain referred to his right sacroiliac joint and gluteal area, presumably resulting from twisting injury occurred while playing basketball one week prior. Magnetic resonance imaging showed obvious intervertebral disc degeneration and a right paracentra a right paracentra a right paracentraa right paracentra a right paracentra a right paracentraa right paracentraa right paracentra l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation l soft disc herniation compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal compressing the spinal cord cord at the T12/L1 level at the T12/L1 level at the T12/L1 levelat the T12/L1 levelat the T12/L1 level at the T12/L1 level at the T12/L1 levelat the T12/L1 level. The patient experienced significant pain relief and was able to regain significant mobility of his mid back within two weeks after starting chiropractic care. Moreover, the patient also reported a multi-year history of nocturnal enuresis without daytime symptoms. He unexpectedly found that the symptoms of enuresis spontaneously resolved during the course of treatment. Monosymptomatic nocturnal enuresis under discussion under discussion under discussion under discussion under discussion under discussion under discussion under discussion under discussion was an uncommon consequence of spinal cord compression (conus medullaris syndrome) caused bycaused by caused by caused by caused by thoracolumbar disc herniation