COMPARISON OF SUBPEDICULAR AND KAMBIN'S TRIANGLE APPROACHES IN TRANSFORAMINAL EPIDURAL INJECTION APPLICATIONS IN CASE OF LUMBAR DISC HERNIA

Objective: The lumbar transforaminal epidural steroid injection (LTFESI) procedure has been used safely in patients with radiculopathic pain secondary to lumbar disc herniation, who did not respond to conservative treatment for many years. In this study, we show that the approach using the Kambin's triangle area is an effective and reliable method of application, as an alternative to the subpedicular approach commonly used in LTFESI. Materials and Methods: Between 2017-2021, 79 patients with symptoms of radiculopathy due to lumbar disc herniation, confirmed by clinical and radiological diagnosis, were included in the study. To the patients: In the operating room, Kambin's triangle in 43 patients and subpedicular approaches in 36 patients were performed with LTFESI, accompanied by scopy image. For radiculopathic pai, Numerical Rating Scale (NRS) and functionally Oswestry Disability Index (ODI) scores were statistically compared in two different approaches before the procedure, at the 2nd week and 3rd month after the procedure. Results: There was no significant difference between the two groups in pre-procedural NRS (p=0.240) and ODI (p=0.517) scoring. It was determined that the change observed in NRS and ODI measurements over time in both approaches showed a statistically significant difference in response to treatment (NRS; p=0.008, ODI; p=0.016). There was no significant difference between the two groups after the procedure, between the NRS (p=0.523) and ODI (p=0.617) scores at the 2nd week and the NRS (p=0.058) and ODI (p=0.056) scores at the 3rd month. Relative treatment effects were found to be similar in the subpedicular and Kambin's triangle groups. Conclusion: It has been shown that the Kambin's triangle area, which is poorer in terms of neurovascular structures, can be used effectively and safely as an alternative to the subpedicular area in LTFESI applications.