The Kumar Technique: A Novel and Effective Approach to Transforaminal Epidural Steroid Injections

Caitlin M Gray; Colby Skinner; Terrie Vasilopoulos; Chamara Gunaratne; Jin Choi; Angela Fadil; Sanjeev Kumar

doi:10.7759/cureus.47210

The Kumar Technique: A Novel and Effective Approach to Transforaminal Epidural Steroid Injections

Cureus. 2023 Oct 17;15(10):e47210. doi: 10.7759/cureus.47210. eCollection 2023 Oct.

Authors

Caitlin M Gray^{1

2}, Colby Skinner¹, Terrie Vasilopoulos^{1

3}, Chamara Gunaratne⁴, Jin Choi¹, Angela Fadil¹, Sanjeev Kumar¹

Affiliations

¹ Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA.
² Department of Anesthesiology, North Florida/South Georgia VA, Gainesville, USA.
³ Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, USA.
⁴ Department of Surgery, University of Florida College of Medicine, Gainesville, USA.

Abstract

Background Transforaminal epidural steroid injections (TFESIs) are widely used as a minimally invasive treatment for lumbar radicular pain. This study presents an alternative approach for lumbar TFESI, the Kumar Technique, which utilizes a more lateral and inferior needle starting point to better align the trajectory of the needle with the neural foramen. We hypothesize the Kumar Technique will result in safer and more effective outcomes than the traditional approach to TFESI. This article was previously presented as a poster at the 2023 University of Florida College of Medicine Celebration of Research on February 27-28, 2023, and as an abstract and poster at the 2023 University of Florida Department of Anesthesiology Celebration of Research on March 29, 2023. Methods The charts for 1,424 patients who received lumbar TFESIs were retrospectively reviewed, and patients were stratified into groups receiving either the traditional approach or the Kumar Technique. Outcomes measures included numerical pain scores, measures of functional status and activity limitations, duration of pain relief, and procedural complications. Results Compared to the group undergoing the traditional approach, patients receiving the Kumar Technique reported a significantly greater decrease in average pain (-2.3 (95% CI: -3.0 to -1.6) vs -1.1 (95% CI: -1.4 to -0.7)) and maximum pain (-2.4 (95% CI: -3.2 to -1.6) vs -1.3 (95% CI: -1.8 to -0.9)). Patients receiving the Kumar Technique had a significantly greater likelihood of reporting any pain relief (OR: 2.10, 95% CI:1.59 to 2.79) compared to those undergoing the traditional approach. In addition, a greater percentage of patients receiving the Kumar Technique experienced at least one month of pain relief compared to the traditional approach (54% vs 40%; z = 3.85, p < 0.001). The occurrence of complications did not significantly vary between the modified (4.1%) and the traditional (3.0%) approaches. Conclusions The Kumar Technique is a modified TFESI approach that allows for improved access to the nerve roots through a more lateral and inferior needle entry point. The analysis supports the benefits of the Kumar Technique with patients experiencing a greater reduction in pain and longer durations of pain relief without increasing the risk of complications.

Keywords: alternative approach; degenerative lumbar spinal stenosis; fluoroscopy guided; lumbar radicular pain; lumbar radiculopathy; transforaminal epidural steroid injection.