Liawrungrueang Wongthawat, Cho Sung Tan, Homlakhorn Jaruphitchaya, Sarasombath Peem
Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand.
Division of Research, School of Medicine, University of Phayao, Phayao, Thailand.
J Spine Surg. 2025 Jun 27;11(2):296-306. doi: 10.21037/jss-24-140. Epub 2025 Jun 23.
Transforaminal epidural steroid injection (TFESI) is a widely employed intervention for managing radicular pain associated with spinal pathology. Among the various techniques utilized for TFESI, the subpedicular and Kambin's triangle approaches are prominent. This study aims to comprehensively evaluate and compare the therapeutic effectiveness and safety profiles of these two techniques of TFESI in alleviating pain and improving functional outcomes.
A retrospective analysis of 100 patients with unilateral radicular leg pain due to single-level lumbar disc herniation (LDH) was conducted. Patients were categorized into two groups: subpedicular TFESI (n=50) and Kambin's triangle TFESI (n=50). Pain intensity was assessed using the numerical rating scale (NRS), and functional outcomes were evaluated via the Oswestry Disability Index (ODI). Data were collected at baseline, immediate post-procedure, and follow-ups at 1, 3, 6, and 8 months. Adverse events, procedure duration, and costs were also analyzed.
Both groups showed significant improvements in NRS and ODI scores from baseline to final follow-up (P<0.001). The mean operation time was 25.55±2.01 min for the subpedicular technique and 24.16±3.56 min for the Kambin's triangle technique, with no significant difference (P=0.23). Similarly, treatment costs were comparable (mean 214±5.32 211±4.36 USD; P=0.43). No significant differences in pain relief, functional improvement, or adverse event rates were observed between the two techniques.
Both the subpedicular and Kambin's triangle techniques for TFESI show comparable efficacy and safety in managing radicular leg pain from LDH. Clinicians can select either method based on patient-specific factors and surgeon preference. However, additional prospective studies are necessary to validate these results and further inform clinical decision-making.
经椎间孔硬膜外类固醇注射（TFESI）是治疗与脊柱病变相关的根性疼痛的一种广泛应用的干预措施。在用于TFESI的各种技术中，椎弓根下和坎宾三角入路较为突出。本研究旨在全面评估和比较这两种TFESI技术在缓解疼痛和改善功能结局方面的治疗效果和安全性。
对100例因单节段腰椎间盘突出症（LDH）导致单侧腿部根性疼痛的患者进行回顾性分析。患者分为两组：椎弓根下TFESI组（n = 50）和坎宾三角TFESI组（n = 50）。使用数字评分量表（NRS）评估疼痛强度，并通过奥斯威斯利功能障碍指数（ODI）评估功能结局。在基线、术后即刻以及1、3、6和8个月的随访时收集数据。还分析了不良事件、手术时间和费用。
从基线到最终随访，两组的NRS和ODI评分均有显著改善（P < 0.001）。椎弓根下技术的平均手术时间为25.55±2.01分钟，坎宾三角技术为24.16±3.56分钟，无显著差异（P = 0.23）。同样，治疗费用相当（平均214±5.32美元对211±4.36美元；P = 0.43）。两种技术在疼痛缓解、功能改善或不良事件发生率方面均未观察到显著差异。
用于TFESI的椎弓根下和坎宾三角技术在治疗LDH引起的腿部根性疼痛方面显示出相当的疗效和安全性。临床医生可根据患者的具体因素和外科医生的偏好选择任何一种方法。然而，需要更多的前瞻性研究来验证这些结果，并为临床决策提供进一步的依据。
