Therapeutic Effect and Outcome Predictors of Sciatica Treated Using Transforaminal Epidural Steroid Injection
Joon Woo Lee1,
Sung Hyun Kim1,
In Sook Lee1,
Jung-Ah Choi1,
Ja-Young Choi2,
Sung Hwan Hong2 and
Heung Sik Kang1
1 Department of Radiology, Seoul National University, Bundang Hospital, 300
Gumi-dong, Bundang-gu, Seong Nam, Gyeongi-Do 463-707, South Korea.
2 Department of Radiology and Institute of Radiation Medicine, Seoul National
University Hospital, Chongno-gu, South Korea.
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Fig. 1A —67-year-old man with sciatica. Posteroanterior (A) and
lateral (B) spot radiographs obtained during intraepineural injection
of transforaminal epidural steroid. Patient was placed in prone position, and
needle tip was inserted to left S1 nerve root. Contrast material is well
demarcated from outer border, a feathery appearance is apparent in central
region, and width of area of opacification is uniform.
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Fig. 1B —67-year-old man with sciatica. Posteroanterior (A) and
lateral (B) spot radiographs obtained during intraepineural injection
of transforaminal epidural steroid. Patient was placed in prone position, and
needle tip was inserted to left S1 nerve root. Contrast material is well
demarcated from outer border, a feathery appearance is apparent in central
region, and width of area of opacification is uniform.
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Fig. 2A —59-year-old man with sciatica. Posteroanterior (A) and
lateral (B) spot radiographs obtained during extraepineural injection
of transforaminal epidural steroid. Patient was in prone position, and needle
tip was inserted to left L5 nerve root. Sharp interface is present between
nerve root and contrast material, which is well demarcated from outer border.
In this case, width of area of opacification is not uniform.
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Fig. 2B —59-year-old man with sciatica. Posteroanterior (A) and
lateral (B) spot radiographs obtained during extraepineural injection
of transforaminal epidural steroid. Patient was in prone position, and needle
tip was inserted to left L5 nerve root. Sharp interface is present between
nerve root and contrast material, which is well demarcated from outer border.
In this case, width of area of opacification is not uniform.
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Fig. 3 —Graph illustrates effectiveness of intraepineural injection
(black bars) and extraepineural injection (white bars) of
transforaminal epidural steroid for treatment of sciatica. Extraepineural
injections were significantly associated with a better outcome (p
< 0.05).
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Fig. 4 —Graph illustrates effectiveness of transforaminal epidural
steroid for treatment of sciatica in patients with saddle-type (white
bars) and non-saddle type (black bars) contrast distribution
pattern. Number of patients with saddle-type distribution pattern was much
greater than with non-saddle type, and saddle-type pattern was associated with
a better outcome; however, this difference in outcome was not statistically
significant.
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Fig. 5 —Graph illustrates relation between cause of sciatica and
effectiveness of transforaminal epidural steroid for treatment of sciatica. No
significant difference in effectiveness was found for patients with sciatica
caused by herniated intervertebral disks (black bars) and those with
sciatica resulting from spinal stenosis (white bars).
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Fig. 6 —Graph illustrates effects of patient age on effectiveness of
transforaminal epidural steroid for treatment of sciatica. Transforaminal
epidural steroid was most effective in 50- to 59-year-old patients (light
gray bars) and least effective in those 70 years old or older (white
bars). No patient was younger than 29 years. Black bars = 30- to
39-year-old age group, dark gray bars = 40- to 49-year-old age group, and
striped bars = 60- to 69-year-old age group.
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Fig. 7 —Graph illustrates effect of patient sex on effectiveness of
transforaminal epidural steroid for treatment of sciatica. No difference was
evident. Black bars = men, white bars = women.
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Fig. 8 —Graph illustrates relation between duration of sciatica and
effectiveness of transforaminal epidural steroid for treatment of sciatica.
Treatment was more effective in patients with sciatica of < 6 months'
duration (acute or subacute, black bars) than in those with sciatica
of > 6 months' duration (chronic, white bars), but this difference
lacked statistical significance.
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Copyright © 2006 by the American Roentgen Ray Society.
