ORIJINAL ARAŞTIRMA
Nöral Foramen ve İntervertebral Diskin Morfolojik Özelliklerinin Transforaminal Epidural Steroid Enjeksiyonunun Başarısına Etkisi: Gözlemsel Bir Çalışma
The Association Between Morphometric Features of Neural Foramen and Intervertebral Disc and Treatment Success of Lumbar Transforaminal Epidural Steroid Injection: An Observational Study
Received Date : 03 Mar 2023
Accepted Date : 13 Jun 2023
Available Online : 16 Jun 2023
Ekim Can ÖZTÜRKa, Elif ZERENb, Ümit Süleyman ŞEHİRLİb, Yasin ARİFOĞLUc,
Savaş ŞENCANd, Osman Hakan GÜNDÜZd
aDepartment of Physical Medicine and Rehabilitation, Division of Algology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
bDepartment of Anatomy, Marmara University Faculty of Medicine, İstanbul, Türkiye
cDepartment of Anatomy, Bezmiâlem University Faculty of Medicine, İstanbul, Türkiye
dDepartment of Physical Medicine and Rehabilitation, Division of Algology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
Doi: 10.31609/jpmrs.2023-96465 - Makale Dili: EN
J PMR Sci. 2023;26(3):257-63
ÖZET
Amaç: Bu çalışmanın amacı, nöral foramen ve intervertebral diskin manyetik
rezonans görüntülemede (MRG) değerlendirilen morfometrik özelliklerinin
transforaminal epidural steroid enjeksiyonunun başarısına etkisini
araştırmaktır. Epidural steroid enjeksiyonundan sonra tedavi başarısını öngören
birkaç klinik ve radyolojik özellik öne sürülmüştür. Bununla birlikte ilgili nöral
foramenlerin morfometrik özelliklerinin transforaminal epidural steroid enjeksiyonuna
verilen cevaba etkisi bilinmemektedir. Gereç ve Yöntemler: Bu çalışma,
prospektif olarak tek taraflı L5 sinir köküne transforaminal epidural steroid enjeksiyonu
uygulanan 45 hastanın katılımıyla gerçekleştirildi. Ağrı şiddeti, dizabilite
ve depresyon düzeyleri başlangıçta, 3. hafta ve 3. ayda değerlendirildi. İlgili
nöral foramen ve intervertebral diskin morfometrileri sagittal MRG taramalarında
değerlendirildi ve tedaviye yanıt veren ve yanıt vermeyen hastalar arasında karşılaştırıldı.
Bulgular: Nöral foramen ve intervertebral diskin yapılan tüm morfometrik
ölçümlerinin iki değerlendirici' arası güvenilirliği yüksek veya
mükemmeldi. Ağrı, depresyon ve dizabilite skorları başlangıca göre 3. ayda
önemli ölçüde iyileşti. Morfometrik değerlendirme açısından yanıt verenler ve
yanıt vermeyenler arasında istatistiksel olarak anlamlı bir fark bulunmadı
(p>0,05). Sonuç: Bu çalışmanın sonuçları, disk yüksekliği, pedikül uzunluğu,
minimum ve maksimum foraminal genişlik, foraminal kesit alanı, sinir kökü kesit
alanı gibi MRG tabanlı morfometrik parametrelerin transforaminal epidural steroid
enjeksiyonu etkinliği üzerinde bir etkisi olmadığını göstermektedir.
Anahtar Kelimeler: Epidural steroid enjeksiyonu; intervertebral foramen; morfometri; nöral foramen
ABSTRACT
Objective: To investigate the impact of morphometric characteristics
of neural foramen (NF) and intervertebral disc (ID) on magnetic resonance
imaging (MRI) to the treatment outcomes after transforaminal epidural steroid
injection (TFESI). Few clinical and radiological features are suggested predicting
treatment success after epidural steroid injection. However, the impact of
morphometric characteristics of the relevant NF to the response to TFESI is unknown.
Material and Methods: This study was carried out prospectively with the
participation of 45 patients who were treated with single level TFESI to L5 nerve
root. Pain intensity, disability, and depression levels were assessed at baseline, 3rd
week and 3rd month. The morphometrics of the relevant NF and ID were evaluated
on sagittal MRI scans and compared between patients who responded and did
not respond to the treatment. Results: The interrater reliability of all morphometric
measurements of NF and ID performed by 2 physicians were high or excellent.
Pain, depression, and disability scores were improved significantly at 3rd
month compared to baseline. No statistically significant difference was found between
responders and non-responders regarding morphometric evaluation
(p>0.05). Conclusion: The results of the present study indicate that MRI based
morphometric parameters like disc height, pedicle length, minimum and maximum
foraminal width, foraminal cross-sectional area (CSA), nerve root CSA
have no effect on the efficacy of TFESI.
Keywords: Epidural steroid injection; intervertebral foramen; morphometry; neural foramen
REFERENCES
- Kozlov N, Benzon HT, Malik K. Epidural steroid injections: update on efficacy, safety, and newer medications for injection. Minerva Anestesiol. 2015;81:901-9. [PubMed]
- Manchikanti L, Knezevic E, Knezevic NN, et al. Epidural injections for lumbar radiculopathy or sciatica: a comparative systematic review and meta-analysis of cochrane review. Pain Physician. 2021;24:E539-E54. [Crossref] [PubMed]
- Manchikanti L, Knezevic E, Knezevic NN, et al. A comparative systematic review and meta-analysis of 3 routes of administration of epidural injections in lumbar disc herniation. Pain Physician. 2021;24:425-40. [Crossref] [PubMed]
- Verheijen EJA, Bonke CA, Amorij EMJ, et al. Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis. Eur Spine J. 2021;30:3255-64. [Crossref] [PubMed]
- Carassiti M, Pascarella G, Strumia A, et al. Epidural steroid injections for low back pain: a narrative review. Int J Environ Res Public Health. 2021;19:231. [Crossref] [PubMed] [PMC]
- Ghai B, Gupta AK, Makkar JK, et al. Contrast medium volume needed to reach anterior epidural space via the kambin triangle or subpedicular approach for transforaminal epidural ınjection. Pain Physician. 2020;23:383-92. [Crossref] [PubMed]
- Park JW, Nam HS, Park Y. Usefulness of posterolateral transforaminal approach in lumbar radicular pain. Ann Rehabil Med. 2011;35:395-404. [Crossref] [PubMed] [PMC]
- Mandell JC, Czuczman GJ, Gaviola GC, et al. The lumbar neural foramen and transforaminal epidural steroid injections: an anatomic review with key safety considerations in planning the percutaneous approach. AJR Am J Roentgenol. 2017;209:W26-W35. [Crossref] [PubMed]
- Ozturk EC, Sencan S, Sacaklidir R, et al. The impact of vitamin D deficiency to treatment success of transforaminal epidural steroid injection. Pain Physician. 2021;24:E619-E24. [Crossref] [PubMed]
- Şencan S, Çelenlioğlu AE, Asadov R, et al. Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica. Turk J Med Sci. 2020;50:126-31. [PubMed] [PMC]
- Cyteval C, Fescquet N, Thomas E, et al. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol. 2006;27:978-82. [PubMed] [PMC]
- Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: Anatomic study on predisposing factors. Spine (Phila Pa 1976). 2002;27:223-9. [Crossref] [PubMed]
- Cramer GD, Cantu JA, Dorsett RD, et al. Dimensions of the lumbar intervertebral foramina as determined from the sagittal plane magnetic resonance imaging scans of 95 normal subjects. J Manipulative Physiol Ther. 2003;26:160-70. [Crossref] [PubMed]
- Browner WS, Newman TB, Stephen B. Hulley SB. Estimating sample size and sower: applications and examples. In: Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB, eds. Designing Clinical Research: An Epidemiologic Approach. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p.81.
- Gkasdaris G, Kapetanakis S. Clinical anatomy and significance of the lumbar intervertebral foramen: A review. J Anat Soc India 2015;64:166-73. [Crossref]
- Rühli FJ, Henneberg M. Clinical perspectives on secular trends of intervertebral foramen diameters in an industrialized European society. Eur Spine J. 2004;13:733-9. [Crossref] [PubMed] [PMC]
- Rühli FJ, Müntener M, Henneberg M. Human osseous intervertebral foramen width. Am J Phys Anthropol. 2006;129:177-88. [Crossref] [PubMed]
- Senoo I. In Vivo Three-Dimensional Morphometric Analysis of the Lumbar Foramen in Healthy Subjects. Changes 2012;29:997-1003. [Crossref]
- Yan S, Zhang Y, Wang K, et al. Three-dimensional morphological characteristics of lower lumbar ıntervertebral foramen with age. Biomed Res Int. 2018;2018:8157061. [Crossref] [PubMed] [PMC]
- Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Med. 2011;12:871-9. [Crossref] [PubMed]
- Ekedahl H, Jönsson B, Annertz M, et al. The 1-year results of lumbar transforaminal epidural steroid ınjection in patients with chronic unilateral radicular pain: the relation to MRI findings and clinical features. Am J Phys Med Rehabil. 2017;96:654-62. [Crossref] [PubMed]
- Yusof MI, Hassan MN, Abdullah MS. The relationship amongst intervertebral disc vertical diameter, lateral foramen diameter and nerve root impingement in lumbar vertebra. Malays Orthop J. 2018;12:21-5. [Crossref] [PubMed] [PMC]
- Wong KW, Ho CH, Yu TC, et al. Clinical outcome of minimally invasive decompression without discectomy in contained foraminal disc herniation: a single-center study. World Neurosurg. 2018;118:e367-e74. [Crossref] [PubMed]
- Chang A, Ng AT. Complications associated with lumbar transforaminal epidural steroid injections. Curr Pain Headache Rep. 2020;24:67. [Crossref] [PubMed]
- Guclu B, Deniz L, Yuce Y, et al. Transforaminal epidural steroid injection in the treatment of pain in foraminal and paramedian lumbar disc herniations. Turk Neurosurg. 2020;30:394-9. [Crossref] [PubMed]