Disclosures: R. Sterling Haring, DO, MPH: No financial relationships or conflicts of interest
Objective: In a cohort of individuals referred to physicians in the extended Vanderbilt Health Affiliated Network for epidural steroid injection, we sought to compare transforaminal vs interlaminar approaches for relief of their primary pain complaint.
Design: Prospective cohort study. Setting : Anesthesia and PM&R-based interventional providers within the Vanderbilt Health Affiliated Network, encompassing a large, socioeconomically and geographically diverse region centered at Nashville, TN.
Participants : A random sample of individuals referred to physicians within the extended Vanderbilt Health Affiliated Network for epidural steroid injection for complaints of presumed-neurogenic back or leg pain.
Interventions: Epidural steroid injections were performed via either transforaminal epidural steroid injection (TFESI) or interlaminar epidural steroid injection (ILESI) approach.
Main Outcome Measures: The primary outcome measure was ≥50% reduction in back or leg pain based on an 11-point numeric rating scale.
Results: Of the 73 patients included in the study, 59 (81%) reported radicular pain, 48 (65%) reported axial back pain, and eleven (15%) reported claudication. Fifty-one (69%) underwent TFESI, while 22 (31%) underwent ILESI. Of the 42 patients with radicular pain undergoing TFESI, 24 (57%) achieved the primary endpoint, vs. six of the 17 (35%) who received ILESI (p=0.128). In the combined radicular and claudication groups, those undergoing TFESI tended to have ≥50% pain reduction more frequently than the ILESI group (56% vs 32%, p=0.08). There was no difference between approaches among those with back pain (31% vs 37.5%, p=0.665). Regression modeling supported TFESI for ≥50% reduction in leg pain in unadjusted (OR 3.1, p=0.04) and adjusted (OR 3.2, p=0.038) models; there was no significant correlation for back pain (OR 0.76, p=0.665). Conclusions: TFESI was more effective at reducing leg pain from neurogenic leg pain (radiculopathy or claudication) than ILESI. Neither was effective at reducing axial back pain.
Level of Evidence: Level III
To cite this abstract in AMA style:
Haring RS, Archer KR, Ehsanian R, Schneider B, Kennedy D. Transforaminal Epidural Steroid Injections are More Effective Than Interlaminar at Reducing Neurogenic Leg Pain [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/transforaminal-epidural-steroid-injections-are-more-effective-than-interlaminar-at-reducing-neurogenic-leg-pain/. Accessed May 15, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transforaminal-epidural-steroid-injections-are-more-effective-than-interlaminar-at-reducing-neurogenic-leg-pain/