Background: Transforaminal epidural steroid injection (TFESI) are commonly employed to treat lumbosacral radiculopathy. Despite anti-inflammatory properties, the addition of 3% hypertonic saline has not been studied.
Objective: Compare the effectiveness of adding 0.9% NaCl (N-group) vs. 3% NaCl (H-group) in TFESI performed for lumbosacral radiculopathy.
Methods: This retrospective study compared TFESI performed with lidocaine, triamcinolone and 0.9% NaCl. The primary outcome was the proportion of patients who experienced a ≥ 30% reduction in pain on a verbal rating scale (VRS; 0-100) at 3 months. Secondary outcome measures included the proportion of patients who improved by at least 30% for pain at 1- and 6-months, and who experienced ≥15% from baseline on the Oswestry disability index (ODI) at follow-up.
Results: The H-group experienced more successful pain outcomes than the N-group at 3 months (59.09% vs. 41.51%; P = 0.002) but not at 1 month (67.53% vs. 64.78%; P = 0.61) or 6 months (27.13% vs 21.55%: P = 0.31). For functional outcome, there was a higher proportion of responders in the H-group than N-group at 3 months (70.31% vs. 53.46%; P = 0.002). Female, age ≤ 60 years and duration of pain ≤ 6 months were associated with superior outcomes at the 3-month endpoint. Although those with a herniated disc experienced better outcomes in general with TFESI, the only difference favoring the H-group was for spondylolisthesis patients.
Conclusions: 3% hypertonic saline is a viable alternative to normal saline as an adjunct for TFESI, with randomized studies needed to compare its effectiveness to steroids as a possible alternative.
Registration: Thai Clinical Trials Registry ID TCTR 20231110006.
Keywords: Epidural steroid injection; herniated disc; hypertonic saline; lumbosacral radicular pain; postlaminectomy syndrome; spinal stenosis; spondylolisthesis; transforaminal.
Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2024.