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Single Level vs. Multilevel Transforaminal Epidural Steroid Injection for Lumbar Pain

August 12, 2017


Transforaminal Epidural Steroid Injections

Transforaminal epidural steroid injections are used to treat pain associated with spinal conditions such as herniated discs, degenerative disc disease, and spinal stenosis. The most common body region that these injections are used is the lumbar spine. This treatment involves placing a needle in the opening between the vertebra known as the intervertebral foramen where the nerve roots come out of the spine. In the lumbar spine, there are usually five nerve roots on each side. Additionally, there are also foramina and nerve roots in the sacrum which is often called the tailbone.

Is Single or Multilevel Better?

A transforaminal epidural steroid injection can be placed at one or more nerve root levels, depending on the pathology being treated. There has been some debate regarding whether or not there was any benefit in injecting at more than one level.

Recently, a study of 266 patients was carried out at the University of Rochester medical Center in Rochester New York. The findings of the study were presented at the 2017 national convention of the American Society of Interventional Pain Physicians (ASIPP).

The study was entitled "Comparison of Single Level and Multilevel Transforaminal Epidural Steroid Injections Utilizing PROMIS Outcomes Data".

This study looked at physical function, pain interference, and depression 3-5 months following either a single level or a multilevel transforaminal epidural steroid injection. The findings of this study concluded that the multilevel injection demonstrated significantly greater improvement in all three of these parameters. The multiple injection group also had a greater proportion reaching MCID (minimal clinically important differences) compared with the single injection group.

in regards to physical function, the multilevel group had a 38.8% improvement compared with the 25% in the single injection group. Likewise, pain interference was improved 48% in the multilevel group compared with 34.5% in the single level group. Pain associated depression was improved 30.6% in the multilevel group compared with 28% in the single level group.

Based on these findings, it appears that using a multilevel transforaminal approach may give superior clinical results for patients suffering with pain secondary to problems such as herniated lumbar disc, degenerative disc disease, and spinal stenosis.

About the Author

Dr. John B. Adams is board certified in Pain Management by the American Board of Medical Specialties and the American Board of Interventional Pain Physicians. With almost 2 decades of experience, he offers patients access to state-of-the-art pain management, emphasizing a multidisciplinary approach to pain management utilizing precision injections, neuromodulation technology, physical therapy, behavioral medicine and judicious use of medications including help with patients titrating off opiates (narcotic pain medications).

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