Epidural Steroid Injections in Post-lumbar Surgery Syndrome After Single-level Discectomy
Failed Back Surgery Syndrome, Low Back Pain, Radiculopathy
About this trial
This is an interventional treatment trial for Failed Back Surgery Syndrome focused on measuring Failed back surgery syndrome, epidural steroid injections
Eligibility Criteria
Inclusion Criteria:
- Age between 18 and 65 years
- Previous single-level, open, non-fusion discectomy for L4-5 or L5-S1 lumbar disc herniation within the past six months
- Having epidural fibrosis involving the L4, L5 or S1 nerve root on magnetic resonance imaging
- Having low back and leg pain for at least six months and unresponsive to conservative therapies
- A Numerical Rating Scale score of ≥4
- Having a single-level epidural fibrosis in the operated level and side as assessed by contrast-enhanced spinal magnetic resonance imaging
Exclusion Criteria:
- Having a multi-level epidural fibrosis
- Previous surgery for multi-level disc herniation
- Previous lumbar fusion surgery
- Having recurrent disc hernia
- Having sacroiliac/facet joint pain
- Having lumbar spinal stenosis, spondylolysis, spondylolisthesis, or scoliosis
- History of epidural steroid injection within the past six months
- Having bleeding diathesis
- Presence of systemic or local infections
- Pregnancy
- Known hypersensitivity to the injectates to be applied
Sites / Locations
- Marmara University Pendik Training and Research Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Transforaminal epidural steroid injection (TESI) group
Caudal epidural steroid injection (CESI) group
This procedure was applied only once. 1 to 2 cc of the contrast agent (300 mg/50 mL iohexol) was given and the distribution pattern was visualized. Once the epidural distribution of the contrast agent was confirmed without vascular flow, a mixture of 40 mg (1mL) of triamcinolone acetonide, 2 cc of physiological saline, and 2 cc (0.5%) of bupivacaine was injected.
This procedure was applied only once 1 to 2 cc of the contrast agent (300 mg/50 mL iohexol) was given and the distribution pattern was visualized which showed bilateral L5-S3 distribution without vascular flow. A mixture of 40 mg (1mL) of triamcinolone acetonide, 7 cc of physiological saline, and 2 cc (0.5%) of bupivacaine was injected. A total of 10 cc mixture was used for CESI.