Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis

Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal StenosisO ne of the degenerative pathologies of the lumbar spine is lumbar spinal stenosis (LSS) and it is a common cause of radicular pain.[1][2][3] The pathology appears as foramen, lateral recess and central stenosis on lumbar magnetic resonance image (MRI).The morphologic classification of LSS on lumbar MRI has been described by measuring the dural sac cross-sectional surface area in the literature.[4] The severe and extreme stenosis is treated with surgery generally and minor or moderate stenosis is treated conservatively.The complaints of patients are low back pain or bilaterally leg pain in a few patients.According to our clinical experience, especially in the foramen and lateral recess ste-Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients.In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically.Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018.We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year.Results: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks.It was 2.8±0.2,3.1±0.1 at three and six months after procedure, respectively.The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively.The mean Oswestry-Disability-Index was 29.6±0.4before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3after two weeks.It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively.The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months.Conclusion: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.