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Does facet tropism negatively affect the response to transforaminal epidural steroid injections? A prospective clinical study

  • Alp Eren CelenlıogluEmail author
  • Savas Sencan
  • Osman Hakan Gunduz
Scientific Article
  • 35 Downloads

Abstract

Objective

To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.

Materials and Methods

We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. The patients were assessed using the Numerical Rating Scale, the Modified Oswestry Disability Index, and the Beck Depression Inventory before the injection and at hour 1, week 3, and month 3 after the injection. Presence of facet tropism was assessed by measuring the facet angles in the L3–4, L4–5, and L5–S1 segments of lumbar MRI T2 sequence axial section.

Results

A significant decrease in the Numerical Rating Scale and an increase in the Modified Oswestry Disability Index scores were detected at all follow-ups in groups comprising 39 patients with and 61 without facet tropism (p < 0.05). On comparison, improvement in clinical parameters at week 3 and month 3 in the group without facet tropism was greater (p < 0.05). As treatment success is considered to be a ≥ 50% reduction in the Numerical Rating Scale scores, 55.2% of the patients attained treatment success at month 3. Further, although the treatment success rate in the group with facet tropism was 34.2%, it was 69% in that without facet tropism (p < 0.05).

Conclusion

Facet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure.

Keywords

Lumbar radicular pain Transforaminal epidural steroid injection Facet tropism 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Kozlov N, Benzon HT, Malik K. Epidural steroid injections: update on efficacy, safety, and newer medications for injection. Minerva Anestesiol. 2015;81(8):901–9.PubMedGoogle Scholar
  2. 2.
    Rivera CE. Lumbar epidural steroid injections. Phys Med Rehabil Clin N Am. 2018;29(1):73–92.CrossRefGoogle Scholar
  3. 3.
    Mandell JC, Czuczman GJ, Gaviola GC, Ghazikhanian V, Cho CH. The lumbar neural foramen and transforaminal epidural steroid injections: an anatomic review with key safety considerations in planning the percutaneous approach. AJR Am J Roentgenol. 2017;209(1):26–35.CrossRefGoogle Scholar
  4. 4.
    McCormick Z, Cushman D, Casey E, Garvan C, Kennedy DJ, Plastaras C. Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain. Arch Phys Med Rehabil. 2014;95(12):2350–6.CrossRefGoogle Scholar
  5. 5.
    Karp JF, Yu L, Friedly J, Amtmann D, Pilkonis PA. Negative affect and sleep disturbance may be associated with response to epidural steroid injections for spine-related pain. Arch Phys Med Rehabil. 2014;95(2):309–15.CrossRefGoogle Scholar
  6. 6.
    Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Med. 2011;12(6):871–9.CrossRefGoogle Scholar
  7. 7.
    Samartzis D, Cheung JP, Rajasekaran S, Kawaguchi Y, Acharya S, Kawakami M, et al. Critical values of facet joint angulation and tropism in the development of lumbar degenerative spondylolisthesis: an international, large-scale multicenter study by the AOSpine Asia Pacific research collaboration consortium. Global Spine J. 2016;6(5):414–21.CrossRefGoogle Scholar
  8. 8.
    Chadha M, Sharma G, Arora SS, Kochar V. Association of facet tropism with lumbar disc herniation. Eur Spine J. 2013;22(5):1045–52.CrossRefGoogle Scholar
  9. 9.
    Farfan HF, Sullivan JD. The relation of facet orientation to intervertebral disc failure. Can J Surg. 1967;10(2):179–85.PubMedGoogle Scholar
  10. 10.
    Karacan I, Aydin T, Sahin Z, Cidem M, Koyuncu H, Aktas I, et al. Facet angles in lumbar disc herniation: their relation to anthropometric features. Spine (Phila Pa 1976). 2004;29(10):1132–6.CrossRefGoogle Scholar
  11. 11.
    Do DH, Taghavi CE, Fong W, Kong MH, Morishita Y, Wang JC. The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain. Eur Spine J. 2011;20(1):71–8.CrossRefGoogle Scholar
  12. 12.
    Boden SD, Riew KD, Yamaguchi K, Branch TP, Schellinger D, Wiesel SW. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am. 1996;78(3):403–11.CrossRefGoogle Scholar
  13. 13.
    Ko HY, Park BK. Facet tropism in lumbar motion segments and its significance in disc herniation. Arch Phys Med Rehabil. 1997;78(11):1211–4.CrossRefGoogle Scholar
  14. 14.
    Ghandhari H, Ameri E, Hasani H, Safari MB, Tabrizi A. Is facet tropism associated with increased risk of disc herniation in the lumbar spine? Asian. Spine J. 2018;12(3):428–33.Google Scholar
  15. 15.
    Lee DY, Ahn Y, Lee SH. The influence of facet tropism on herniation of the lumbar disc in adolescents and adults. J Bone Joint Surg Br. 2006;88(4):520–3.CrossRefGoogle Scholar
  16. 16.
    Ugue I, Okada S, Masuda M, Ueta T, Maeda T, Shiba K. Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography. Eur Spine J. 2016;25(5):1542–9.CrossRefGoogle Scholar
  17. 17.
    Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural steroid injections provide short-and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res. 2015;473(6):1940–56.CrossRefGoogle Scholar
  18. 18.
    Cyron BM, Hutton WC. Articular tropism and stability of the lumbar spine. Spine (Phila Pa 1976). 1980;5(2):168–72.CrossRefGoogle Scholar
  19. 19.
    Farfan HF, Cossette JW, Robertson GH, Wells RV, Kraus H. The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. J Bone Joint Surg Am. 1970;52(3):468–97.CrossRefGoogle Scholar
  20. 20.
    Masharawi Y, Rothschild B, Salame K, Dar G, Peleg S, Hershkovitz I. Facet tropism and interfacet shape in the thoracolumbar vertebrae: characterization and biomechanical interpretation. Spine (Phila Pa 1976). 2005;30(11):281–92.CrossRefGoogle Scholar
  21. 21.
    Kim HJ, Chun HJ, Lee HM, Kang KT, Lee CK, Chang BS, et al. The biomechanical influence of the facet joint orientation and the facet tropism in the lumbar spine. Spine J. 2013;13(10):1301–8.CrossRefGoogle Scholar
  22. 22.
    Fazey PJ, Song S, Monsas S, Johansson L, Haukalid T, Price RI, et al. An MRI investigation of intervertebral disc deformation in response to torsion. Clin Biomech (Bristol, Avon). 2006;21(5):538–42.CrossRefGoogle Scholar
  23. 23.
    Schmidt H, Kettler A, Heuer F, Simon U, Claes L, Wilke HJ. Intradiscal pressure, shear strain, and fiber strain in the intervertebral disc under combined loading. Spine (Phila Pa 1976). 2007;32(7):748–55.CrossRefGoogle Scholar
  24. 24.
    Drake JD, Aultman CD, McGill SM, Callaghan JP. The influence of static axial torque in combined loading on intervertebral joint failure mechanics using a porcine model. Clin Biomech (Bristol, Avon). 2005;20(10):1038–45.CrossRefGoogle Scholar
  25. 25.
    Okuda S, Oda T, Miyauchi A, Tamura S, Hashimoto Y, Yamasaki S, et al. Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine. 2008;33(25):2754–8.CrossRefGoogle Scholar
  26. 26.
    Roy C, Chatterjee N, Patro SN, Chakraborty A, Kumar GV, Sengupta R. The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy. Neurol India. 2011;59(5):685–9.CrossRefGoogle Scholar
  27. 27.
    Ahadian FM, McGreevy K, Schulteis G. Lumbar transforaminal epidural dexamethasone: a prospective, randomized, double-blind, dose-response trial. Reg Anesth Pain Med. 2011;36(6):572–8.CrossRefGoogle Scholar
  28. 28.
    Benny B, Azari P. The efficacy of lumbosacral transforaminal epidural steroid injections: a comprehensive literature review. J Back Musculoskelet Rehabil. 2011;24(2):67–76.CrossRefGoogle Scholar
  29. 29.
    Kaufmann TJ, Geske JR, Murthy NS, Thielen KR, Morris JM, Wald JT. Clinical effectiveness of single lumbar transforaminal epidural steroid injections. Pain Med. 2013;14(8):1126–33.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  • Alp Eren Celenlıoglu
    • 1
    Email author
  • Savas Sencan
    • 2
  • Osman Hakan Gunduz
    • 3
  1. 1.Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of MedicineErciyes UniversityKayseriTurkey
  2. 2.Department of Physical Medicine and Rehabilitation, Division of Pain MedicineFaculty of Medicine, Marmara UniversityIstanbulTurkey
  3. 3.Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of MedicineMarmara UniversityIstanbulTurkey

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