Therapeutic trial of fluoroscopic interlaminar epidural steroid injection for axial low back pain: effectiveness and outcome predictors

AJNR Am J Neuroradiol. 2010 Nov;31(10):1817-23. doi: 10.3174/ajnr.A2180. Epub 2010 Jul 8.

Abstract

Background and purpose: An ESI for managing LBP is one of the most commonly performed interventions. The purpose of this observational study was to assess the effect of a therapeutic trial of a fluoroscopic interlaminar ESI for axial LBP and to analyze the outcome predictors.

Materials and methods: All patients who received an interlaminar ESI for axial LBP at our facility in 2007 and 2008 were included. Initial short-term follow-up was done at <1 month after ESI. ESI was considered effective if patients had a reduction of >50% in their pain scores. In July 2009, telephone interviews were conducted by using formatted questions including the NASS patient-satisfaction index. The symptom-free interval was computed by the Kaplan-Meier method. Outcome predictors such as age, sex, duration of LBP, and MR imaging findings were statistically analyzed by the Mann-Whitney U and the Fisher exact tests.

Results: Eighty-one patients (male/female = 16:65; mean age, 49.9 years; range, 17-77 years) were included in the study. The interlaminar ESI was effective in 63 of the 81 patients (77.8%) at initial short-term follow-up. For the 63 patients in whom ESI was effective, the median symptom-free interval was 154 days (95% CI, 96-212 days). Among 68 patients for whom telephone interviews were possible, 44 patients (64.7%) replied positively to the NASS patient satisfaction index (NASS patient-satisfaction index, 1 or 2). There were no significant outcome predictors.

Conclusions: The therapeutic trial of a fluoroscopic interlaminar ESI was effective for axial LBP without significant outcome predictors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Fluoroscopy / methods*
  • Follow-Up Studies
  • Humans
  • Injections, Epidural / methods*
  • Kaplan-Meier Estimate
  • Low Back Pain / diagnostic imaging*
  • Low Back Pain / drug therapy*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Predictive Value of Tests
  • Retrospective Studies
  • Steroids / administration & dosage*
  • Treatment Outcome
  • Young Adult

Substances

  • Steroids