Comparison of the Results of Combined Epidural Steroid Injection with Other Approaches in Lumbar Disc Herniation: A Retrospective Study

Background: Epidural steroid injection (ESI) is a minimally invasive treatment for lumbar disc herniation (LDH). It can be applied using a transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), or combined (TFESI + CESI) approach. Aim: To compare the effectiveness of the three ESI approaches and the combined ESI application in reducing pain in patients with single or multi-level LDH. Methods: In this retrospective study, we included 239 patients diagnosed with LDH (who complained of low back pain for at least 3 months, had no neurological deficit or history of lumbar surgery, and were not contraindicated for ESI application) who received ESI and were followed up clinically for 2 years. Demographic (age, sex, body mass index (BMI)) and clinical data (duration of low back pain, visual analog scale (VAS) scores before and after ESI, and procedure-related information) were obtained from medical records. The VAS scores noted before treatment and at 3 months, 1 year, and 2 years after ESI were compared. Results: The post-treatment VAS scores of the combined ESI (TFESI + CESI) group were significantly lower than those of other approaches applied alone ( P < 0.05). Furthermore, VAS scores of the ILESI and CESI groups were significantly lower than those of the TFESI group at all three post-treatment time points ( P < 0.05). The patient’s age and BMI were weakly correlated with the post-treatment VAS scores. Conclusion: Combined ESI is more effective than any single-approach ESI in LDH and should be considered in suitable patients to increase treatment effectiveness.