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The Impact of Lumbosacral Transitional Vertebrae on Therapeutic Outcomes of Transforaminal Epidural Injection in Patients with Lumbar Disc Herniation
Author(s) -
Son KangMin,
Lee SunMi,
Lee Gun Woo,
Ahn MyunHwan,
Son JungHwan
Publication year - 2016
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12315
Subject(s) - medicine , oswestry disability index , visual analogue scale , lumbosacral joint , lumbar disc herniation , disc herniation , low back pain , lumbar , lumbar vertebrae , surgery , therapeutic effect , anesthesia , alternative medicine , pathology
Background Although some studies have evaluated the clinical impact of lumbosacral transitional vertebrae ( LSTV ), few have attempted to determine an effective conservative treatment method for lumbar disc herniation ( LDH ) presenting concurrently with LSTV . Methods We prospectively enrolled 291 consecutive patients who were followed‐up for at least one year after transforaminal epidural injection ( TFEI ) for LDH . We confirmed the presence of LSTV with Paik et al.'s method, the Castellvi classification, and the Southworth and Bersack method. Clinical outcomes were evaluated with a visual analogue scale ( VAS ) for pain intensity and the Oswestry Disability Index ( ODI ) for functional status. Results Of the 291 patients, 47 (16.2%) had LSTV , including 33 with sacralization and 14 with lumbarization, while 244 (83.8%) did not have LSTV . Patients in both groups improved significantly after TFEI in terms of the VAS ( P < 0.001) and ODI ( P < 0.001) scores. However, LDH patients with LSTV had a worse clinical outcome after six months of TFEI than did those without LSTV , with a significant difference between groups for both the VAS ( P < 0.01) and ODI ( P = 0.01) scores. LDH patients with sacralization had worse post‐treatment clinical outcomes than LDH patients with lumbarization ( P < 0.001) or LDH patients without LSTV ( P < 0.001). Conclusions Sacralization can reduce the improvement after TFEI among LDH patients, while lumbarization appears to have no direct effect on TFEI outcomes. The presence of sacralization should be identified before TFEI , and if present, patients should be informed that the outcomes of TFEI may not be as good as they would be if sacralization was not present.