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Results of lumbar transforaminal epidural steroid injections based on the physician referral source.

Results of lumbar transforaminal epidural steroid injections based on the physician referral source. Interventional pain medicine Levin, J., Li, W., Gall, N., Chan, J., Caragea, M., Huynh, L., Koltsov, J., Smuck, M. 2022; 1 (3): 100114

Abstract

Background: Many patients who receive lumbosacral transforaminal epidural steroid injections (TFESIs) are referred for the injection from a physician who does not perform the procedure.Purpose: To compare success rates of fluoroscopically guided lumbosacral TFESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B).Study design/setting: Retrospective, observational, in vivo study of consecutive patients. Patient.Sample: Patients undergoing lumbosacral TFESIs at a single outpatient academic spine center. Outcome.Measures: Numeric Rating Scale (NRS) pain score improvement.Methods: Current procedural terminology (CPT) codes were used to search all consecutive patients who received a lumbosacral TFESI between September 2019 and September 2020. All patients with pre- and post-injection NRS pain scores within 60 days of the injection were included in the analysis.Results: A total of 230 TFESIs were analyzed, 151 in Group A, and 79 in Group B. The primary outcome was defined as > 50% improvement in the NRS pain score. 39% [95% CI: 33, 45%] of all patients who received a lumbosacral TFESI achieved a successful outcome. There were better results in Group A with a 47% [95% CI: 39, 55%] success rate compared to a 23% [95% CI: 14, 32%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (26% [95% CI: 19, 33%]) compared to Group B (10% [95% CI: 3, 17%]). History of prior surgery did not significantly affect outcomes.Conclusion: This retrospective study demonstrated a higher success rate from lumbosacral TFESIs when patients were referred for the injection by a physician who performs ESIs.

View details for DOI 10.1016/j.inpm.2022.100114

View details for PubMedID 39238527