Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea.
Pain Physician. 2012 Sep-Oct;15(5):415-20.
Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD.
To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients.
A retrospective design.
There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections.
There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups.
A relatively small numbers of cases were included in the FHLD group.
The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients.
由于腰椎间盘远外侧突出（FHLD）与腰椎间盘椎管内突出（iHLD）的解剖学差异，经皮椎间孔硬膜外类固醇注射（TFESI）治疗 FHLD 患者的效果似乎与 iHLD 患者不同。然而，很少有研究评估 TFESI 在 FHLD 中的疗效。
评估和比较 TFESI 在 FHLD 和 iHLD 患者中的疗效。
回顾性设计。
FHLD 组和 iHLD 组患者分别为 15 例和 70 例。患者接受了透视引导下的 TFESI。记录 TFESI 的失败率，并在初始注射前、注射后 2 周、6 周和 12 周进行问卷调查，包括腿部疼痛视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）。
iHLD 组无 TFESI 失败，而 FHLD 组中有 9 例因 TFESI 进针时出现刺痛性腿痛而需要进行替代阻滞。iHLD 组注射后 12 周 VAS 和 ODI 评分有统计学显著改善。考虑到 FHLD 组只有成功病例，FHLD 组在注射后 12 周 VAS 和 ODI 评分也有显著改善。此外，两组之间 VAS 和 ODI 评分无统计学差异。
FHLD 组纳入的病例数相对较少。
本研究表明，对于 FHLD 患者，TFESI 的替代针位技术似乎是必要的。
