Lumbosacral transforaminal epidural steroid injections are equally effective for treatment of lumbosacral radicular pain in the obese compared to non-obese population: A pilot study1
Affiliations: [a] Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern University, Chicago, IL, USA | [b] Department of Physical Medicine and Rehabilitation, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Correspondence:
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Address for correspondence: Zack McCormick, Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern University, 780 S Federal St., Apt. 1201, Chicago, IL, USA. Tel.: +1 510 388 7084; E-mail: zmccormi@gmail.com
Note: [1] This research was approved by the Northwestern University Institutional Review Board and the University of Pennsylvania Institutional Review Board.
Abstract: Background and Objectives:Current evidence suggests that lumbosacral transforaminal epidural steroid injection (TFESI) is an effective treatment for lumbosacral radicular pain. However, practitioners may be reluctant to attempt this intervention in obese patients because of a perceived reduction in the chance of providing pain relief due to the increased technical difficulty of TFESI in individuals with a larger body habitus. No study to date has compared the effectiveness of TFESI in groups stratified by BMI. We report pilot data addressing whether lumbosacral transforaminal epidural steroid injection is as effective in treating lumbosacral radicular pain in the obese and overweight population as it is in the non-overweight population. Material and Methods:This study consisted of 9 normal weight (18.5 < BMI < 25), 9 overweight (25 < BMI < 30), and 6 obese (BMI > 30) patients who presented with lumbosacral radicular pain and received a TFESI. For each group, percent reduction in pain and the proportion of individuals with a 50% or greater reduction in pain 2–4 weeks after TFESI was determined. Results:Comparing the overweight and obese groups to the normal weight group, no significant differences were found in the percent improvement in pain after TFESI (p=0.7154, p=0.4566) or in the proportion of each group with a 50% or greater reduction in lower back pain after TFESI (p=0.2968). Conclusion:Our pilot data indicates that lumbosacral TFESI is as effective in providing short-term relief of lumbosacral radicular pain in obese and overweight patients as it is in non-overweight patients. However, our sample size was not large enough to find a significant difference at a power of 80%. We plan to perform a larger prospective study to confirm the findings of this study. Level of Evidence:Case-control study, Level II-2.
Keywords: Epidural injection, BMI, body mass index, obese, radiculopathy
