Presented at the 2012 AAPM Annual Meeting « Back

Comparing Midline Versus Lateral Parasagittal Approach During Fluoroscopically Guided Interlaminar Lumbar Epidural Steroid Injection

Kenneth D. Candido, MD, kdcandido@yahoo.com¹, N. Nick Knezevic, MD PhD¹, Andrew Germanovich, DO1, Vinaya Puppala, MD¹, Jonathan Kamerlink, MD¹ (1) Advocate Illinois Masonic Medical Center, Chicago, Illinois

Introduction: The purpose of this study is to compare two different approaches (midline and parasagittal) during interlaminar lumbar epidural steroid injection (LESI). Methods: After IRB approval, we included 44 patients with history of unilateral lumbosacral radiculopathic pain undergoing LESI. The patients randomly assigned to one of two groups, based on the approach: group I (22 patients) – midline (MIL) approach, and Group II (22 patients) – parasagittal interlaminar (PIL) approach. The pain scores on the numeric rating scale (NRS) were recording at rest and during movement 20 minutes before procedure, and on days 1, 7, and 28 after the injection. Results: There was no difference between these two groups with respect to age, gender, height, weight, or duration of symptoms. The average NRS before injection was 5.4±2.1 at rest and 7.1±2.6 during movement in the MIL group, and 5.1±2.8 at rest and 7.6±2.4 during movement in the PIL group. LESI (both approaches) clinically and statistically significantly reduced unilateral lumbosacral radiculopathic pain at rest and during movement. However, the improvement over the time was better in the PIL group. Statistical significance for NRS at rest was 0.026 in the PIL group, and 0.044 in the MIL group. Statistical significance for NRS during movement was 0.005 in the PIL group (p<0.001 highly statistically significant), and 0.019 in the MIL group. Conclusion: Even though both groups of patients had significant improvement, the parasagittal approach was slightly more effective than the midline approach in targeting low back pain with radiculopathy secondary to lumbar disk disease. References: 1)Abdi S, et al. Pain Physician 2007; 10: 185-212 2)Candido KD, et al. Anesth Analg 2008; 106: 638-44

Funding: None