Comparison of the results of combined epidural steroid injection with other approaches in lumbar disc herniation: a retrospective study

Abstract

Background: Epidural steroid injection (ESI) is a minimally invasive treatment for lumbar disc herniation (LDH). It can be applied using a transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), or combined (TFESI + CESI) approach.

Aim: To compare the effectiveness of the three ESI approaches and the combined ESI application in reducing pain in patients with single or multi‑level LDH.

Methods: In this retrospective study, we included 239 patients diagnosed with LDH (who complained of low back pain for at least 3 months, had no neurological deficit or history of lumbar surgery, and were not contraindicated for ESI application) who received ESI and were followed up clinically for 2 years. Demographic (age, sex, body mass index (BMI)) and clinical data (duration of low back pain, visual analog scale (VAS) scores before and after ESI, and procedure‑related information) were obtained from medical records. The VAS scores noted before treatment and at 3 months, 1 year, and 2 years after ESI were compared.

Results: The post‑treatment VAS scores of the combined ESI (TFESI + CESI) group were significantly lower than those of other approaches applied alone (P < 0.05). Furthermore, VAS scores of the ILESI and CESI groups were significantly lower than those of the TFESI group
at all three post‑treatment time points (P < 0.05). The patient’s age and BMI were weakly correlated with the post‑treatment VAS scores.

Conclusion: Combined ESI is more effective than any single‑approach ESI in LDH and should be considered in
suitable patients to increase treatment effectiveness.