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Does facet tropism negatively affect the response to transforaminal epidural steroid injections? A prospective clinical study

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Abstract

Objective

To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.

Materials and Methods

We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. The patients were assessed using the Numerical Rating Scale, the Modified Oswestry Disability Index, and the Beck Depression Inventory before the injection and at hour 1, week 3, and month 3 after the injection. Presence of facet tropism was assessed by measuring the facet angles in the L3–4, L4–5, and L5–S1 segments of lumbar MRI T2 sequence axial section.

Results

A significant decrease in the Numerical Rating Scale and an increase in the Modified Oswestry Disability Index scores were detected at all follow-ups in groups comprising 39 patients with and 61 without facet tropism (p < 0.05). On comparison, improvement in clinical parameters at week 3 and month 3 in the group without facet tropism was greater (p < 0.05). As treatment success is considered to be a ≥ 50% reduction in the Numerical Rating Scale scores, 55.2% of the patients attained treatment success at month 3. Further, although the treatment success rate in the group with facet tropism was 34.2%, it was 69% in that without facet tropism (p < 0.05).

Conclusion

Facet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, 38030, Kayseri, Turkey

    Alp Eren Celenlıoglu

  2. Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, 34906, Istanbul, Turkey

    Savas Sencan

  3. Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, 34906, Istanbul, Turkey

    Osman Hakan Gunduz

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  1. Alp Eren Celenlıoglu
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Correspondence to Alp Eren Celenlıoglu.

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Celenlıoglu, A.E., Sencan, S. & Gunduz, O.H. Does facet tropism negatively affect the response to transforaminal epidural steroid injections? A prospective clinical study. Skeletal Radiol 48, 1051–1058 (2019). https://doi.org/10.1007/s00256-018-3129-8

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  • DOI: https://doi.org/10.1007/s00256-018-3129-8

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