Assessing the effectiveness of fluoroscopy-guided transforaminal and caudal epidural steroid injections in alleviating chronic pain post-spinal surgery

Abstract

Background: Chronic Pain following Spinal Surgery (CPSS), formerly known as Failed Back Surgery Syndrome, is characterised by persistent or recurring back pain or leg pain occurring beyond three months post spinal surgery (TLIF/PLIF) CPSS patients experience significant functional disability and report a lower quality of life compared to individuals with other chronic pain conditions. The objective of this study is to compare the advantages, safety, and mid-term effects of fluoroscopy-guided transforaminal (TF) epidural steroid injection (ESI) to caudal (CA) epidural steroid injection in patients experiencing chronic pain after spinal surgery (CPSS). The study aims to assess the effectiveness of pain relief and improvement in functionality resulting from these two approaches.Materials and Methods: This was a retrospective study that included 30 patients who underwent fluoroscopy-guided transforaminal (TF) or caudal epidural steroid injection (CESI) for the diagnosis CPSS between April 2022 and December 2022.The frequencies of complications, adverse events, treatment effects, and functional improvements were compared between the two procedures with a follow up period of 6 months.Results: Oswestry Disability Index (ODI) scores demonstrated improvement in both groups at 6 months period, without meaningful difference between groups. Patients in TFESI group had an ODI score with an average of 18.1 ranging from 16 to 22, while the CESI group averaged 18.7 ranging from 12 to 22. The amount of time used for the injection procedure was shorter in CESI group than in TFESI group. All patients were happy with the procedure and the functional outcome.Conclusion: The results of the present study indicate that fluoroscopy-guided cervical interlaminar epidural steroid injection (CESI) and transforaminal epidural steroid injection (TFESI) are equally effective in reducing pain and improving function in patients with cervical radicular pain. Patients experience less discomfort during the injection and report higher satisfaction with the CA approach. Both methods are effective, but the CA approach tends to provide better patient satisfaction and a shorter procedure time.