Comparative Study between Treatment of Chronic Lower Back Pain with Transforaminal Steroid Injection and Conservative treatment in Patients with Lumbar Disc Bulging

Background: Chronic low back pain from lumbar disc bulging is a leading cause of disability. While conservative therapy is first-line, transforaminal epidural steroid injections (TFESIs) may offer superior outcomes. Objective: To compare the effectiveness of TFESIs versus conservative treatment in patients with chronic low back pain due to lumbar disc bulging. Methods: This prospective comparative study included 50 patients (25 TFESI, 25 conservative) at Al-Azhar University Hospital, Damietta (Sept 2024–Apr 2025). TFESI patients received betamethasone acetate (4 mg) with lidocaine under fluoroscopic guidance; conservative treatment comprised NSAIDs and muscle relaxants. Pain (VAS), MRI findings, Oswestry Disability Index (ODI), patient satisfaction, analgesic use, and complications were assessed at baseline, 1, 3, and 6 months. Results: TFESI showed significantly greater pain reduction at 3 months (VAS 2.5 vs 3.0; p=0.03) and 6 months (1.0 vs 1.9; p=0.011). MRI showed higher rates of disc regression at 6 months in TFESI (72% vs 36%; p=0.007) and greater nerve root decompression (48% vs 24%; p=0.041). Patient satisfaction was higher in TFESI (84% vs 32%; p<0.001), and analgesic use was lower, with no opioid use in TFESI patients. ODI improved significantly in TFESI (p=0.04) but not in the conservative group (p=0.25). Complications occurred in 24% of TFESI cases, all mild and self-limiting (e.g., facial flushing, transient hyperglycemia). Conclusion: TFESI is more effective than conservative treatment in reducing pain, improving radiological and functional outcomes, and enhancing patient satisfaction in chronic low back pain due to lumbar disc bulging, with minimal complications.