Presented at the 2012 AAPM Annual Meeting « Back

The Role of Concordant Pressure Paresthesia in Determining Outcome During Fluoroscopically Guided Lumbar Epidural Steroid Injection

Kenneth D. Candido, MD, kdcandido@yahoo.com¹, N. Nick Knezevic, MD PhD¹, Maunak V. Rana, MD¹, Anthony Tharian, MD¹, Andrew Germanovich, DO¹, (1) Advocate Illinois Masonic Medical Center, Chicago, Illinois

Introduction: Our hypothesis was that a pressure paresthesia occurring during the lumbar epidural injection of corticosteroids (LESI) in the same distribution of the radicular pain will give prognostic information. Methods: Forty-four consenting adult patients undergoing LESI for radicular low back pain were prospectively assigned randomly to one of two groups: Group I (22 patients) – got LESI using midline (MIL), and Group II (22 patients) – using parasagittal interlaminar (PIL) approach. The patients were asked to confirm whether pressure paresthesia was in distribution of “usual and customary pain” and they were also asked to grade a pressure paresthesia on the scale from 0 to 3 ispilaterally and contralaterally. Results: There was no statistically significant difference between these two groups with respect to age, gender, height, weight, or duration of symptoms. Most of the patients with PIL approach had pressure paresthesia in the distribution of usual and customary pain (82%), and only 32% of patients from MIL group (p = 0.002). Most of the patients from the PIL group felt moderate to severe paresthesia ipsilaterally (18 out of 22), and only one patient had no paresthesia. However, in the MIL group most of the patients had either no paresthesia or mild paresthesia (19 out of 22), and only three of them had moderate or severe paresthesia. The difference between these two groups was highly statistically significant (p<0.0001). Conclusion: The pressure paresthesia occurring during the LESI in the same distribution of the radicular pain could be used as an indicator of proper achievement of medication target. References: 1)Boswell MV, et al. Pain Physician 2005; 8: 1-47 2)Abdi S, et al. Pain Physician 2007; 10: 185-212 3)Manchikanti L. Pain Physician 2004; 7: 465-82

Funding: None