The use of transforaminal epidural block in patients with herniated discs and radicular pain

Objective. To  study the efficacy and safety of transforaminal epidural block (TEB) in patients with herniated intervertebral discs, as well as to compare the results of their treatment with those achieved in patients who were treated with other methods.

Material and Methods. The results of treatment of 248 patients with herniated intervertebral discs and persistent radicular pain syndrome, who had indications for surgical treatment, were studied. In 70 cases, the TEB was performed, and in case of its low efficacy (less than 50 % reduction in pain severity), surgical intervention was suggested. In 178 cases, surgical treatment was performed – microsurgical or endoscopic discectomy. The state of patients was followed-up during two years using VAS, Oswestry questionnaire and MRC scale for motor dysfunction in the limb.

Results. After 1 month, a decrease in the intensity of radicular pain (by 50 % or more) was determined in the TEB group with a lower frequency (84.3 %) than in the surgical treatment group (93.8 %), without a statistically significant difference (p = 0.526). At the same time, a stable reduction in radicular pain (by 50 % or more) without the need for surgical treatment was achieved in 62.9 % of patients in the TEB group. Also, there was not significant difference in VAS score for local low back pain (p = 0.179) and ODI score (p = 0.348) between groups. After 24 months, the benefits of functional outcomes in the TEB group as compared with the surgical treatment group were confirmed by median ODI (4 [0; 8] vs 12 [4; 20], respectively)  and median VAS for low back pain (0 [0; 1] vs 1 [0; 3], respectively), p < 0.001. A significant (50 % or more) decrease in VAS score for radicular pain was achieved in all patients of the TEB group, while in the surgical treatment group – in 88.8 % (p > 0.05). In the TEB group, a stable analgesic effect without subsequent surgical intervention was achieved in 42 (60.0 %) patients, and the  number of repeated surgical interventions performed for various reasons was significantly  lower (p = 0.001), with a comparable incidence of disc herniation recurrence among operated patients who required repeated surgical treatment (p > 0.05).

Conclusion. The use of transforaminal epidural block (TEB) in the treatment of patients with herniated intervertebral discs at the lumbar level and persistent radicular pain makes it possible to avoid surgical treatment in 62.9 % of patients in the short term, and in 60.0 % during two year follow-up after the procedure, while maintaining a high quality of life.

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