Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial

Objective The aim of this study was to invastigate the effect of the sacralization on the results of transforaminal epidural steroid injection for radicular low back pain. Materials and methods The study included 64 patients diagnosed with radicular low back pain due to unilateral and single-level lumbar disk herniation. Patients were divided into 2 groups: patients with sacralization (Group S) and patients without lumbosacral transitional vertebrae (Group A). Injection was applied to the relevant level. Patients were evaluated with Numeric Rating Scale and Modified Oswestry Disability Index before, at week 3 and month 3 after the procedure. Sacralization presence was determined by MRI. Sacralization was categorized by anteroposterior lumbar radiography using Castellvi classification. Treatment success was considered as ≥ 50% reduction in NRS scores. Results Numeric Rating Scale and Modified Oswestry Disability Index scores decreased in both groups on both week 3 and month 3 ( p < 0.05). Pain scores of Group S (median value 5 (3–6)) were significantly higher than Group A ((median value 3 (0–5)) in the third month follow-up ( p = 0.026), but no significant difference was observed at other time points. There was no significant difference in Modified Oswestry Disability Index scores between the groups at all follow-ups ( p > 0.05). Treatment success in the third month was 44.8% in Group S and 65.6% in Group A. Conclusion Transforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success.