# Comparison of epidural space contrast flow and clinical outcomes in parasagittal versus transforaminal epidural steroid injection

## TL;DR

This study compares two methods of epidural steroid injections and finds similar clinical outcomes but fewer imaging needs with one approach.

## Contribution

Demonstrates high-volume PIL-ESI is as effective as TF-ESI with reduced fluoroscopic imaging requirements.

## Key findings

- No significant differences in pain relief or quality of life between the two injection methods.
- The TF group required significantly more fluoroscopic images than the PIL group.
- High-volume PIL-ESI achieved equivalent anterior contrast spread to TF-ESI.

## Abstract

Epidural steroid injections (ESI) are frequently used to treat lumbosacral radicular pain, but the solute spread in the epidural space needs further investigation. This semi-blind, randomized study assessed clinical outcomes and contrast spread patterns between the parasagittal interlaminar (PIL) and transforaminal (TF) approaches in 79 adults with low back pain. Participants were randomly assigned to receive either TF-ESI (3 ml) or high-volume PIL-ESI (10 ml). All procedures were performed under fluoroscopic guidance. Contrast spread was evaluated by a blinded pain specialist, and clinical outcomes, including analgesia, patient satisfaction, and quality of life, were measured at two weeks, one month, two months, and six months post-treatment. Results showed no differences in baseline characteristics between groups. There were no statistically significant differences between the two groups in mean pain intensity at baseline and six months after treatment (p = 0.590 and 0.484, respectively). Pain relief, satisfaction, quality of life, and contrast spread to the anterior epidural space did not differ over six months. However, the TF group required significantly more fluoroscopic images (p < 0.001). High-volume PIL-ESI provides clinical efficacy and anterior contrast distribution equivalent to TF-ESI, with fewer fluoroscopic images needed.