{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:57:26Z","timestamp":1772852246796,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>There are no formal guidelines for whether CT-guided or fluoroscopy-guided TFESI should be undertaken for patients with symptoms of lumbar nerve root irritation and corresponding nerve impingement. Here, we sought to compare the efficacy, safety and cost of computer tomography (CT)-guided and fluoroscopically guided transforaminal epidural steroid injection (TFESI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>All patients who underwent lumbar TFESI at our institution between June 2016 and June 2018 were identified. Six-week follow-up outcomes were categorised. The radiation doses and associated cost was retrieved from our institution\u2019s costing system.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One hundred and sixteen patients were included (CT\u201450; fluoroscopy\u201456). There were no complications. More patients were discharged 6\u00a0weeks after CT-guided lumbar TFESI when compared with fluoroscopically guided TFESI (CT\u201423, fluoroscopy\u201414 (<jats:italic>P<\/jats:italic>\u2009=\u20090.027)). There was no difference in the number of patients who were referred to surgery (<jats:italic>P<\/jats:italic>\u2009=\u20090.18), for further pain management (<jats:italic>P<\/jats:italic>\u2009=\u20090.45), or for further TFESI (<jats:italic>P<\/jats:italic>\u2009=\u20090.43). The effective radiation dose was significantly higher for CT-guided TFESI (CT\u20145.73\u00a0mSv (3.87 to 7.76); fluoroscopy\u20140.55\u00a0mSv (0.11 to 1.4) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01)). The total cost for CT-guided lumbar TFESI was \u00a3237.50 (\u00a3235 to \u00a3337), over \u00a3800 less than under fluoroscopic guidance (\u00a31052 (\u00a3892.80 to \u00a31298.00), <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01)). Removing cost associated with staff and theatre use (staffing, theatre, medical indemnity and overheads) revealed CT-guided lumbar TFESI to be less expensive than if the procedure was fluoroscopy-guided\u2014CT-guided: \u00a3132.6 (130.8 to 197.5); fluoroscopy: \u00a3237.4 (\u00a3209.2 to \u00a3271.9) (<jats:italic>P<\/jats:italic>\u2009=\u20090.019).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CT-guided TFESI was associated with a higher discharge rate, a lower cost, but a ten times higher radiation dose when compared with fluoroscopically guided TFESI. Prospective studies are required to compare the efficacy of these procedures and to investigate how the radiation dose of CT-guided TFESI can be reduced without jeopardising efficacy or safety.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04436-y","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T11:04:20Z","timestamp":1649934260000},"page":"2355-2361","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["CT-guided vs. fluoroscopically guided transforaminal epidural steroid injections for lumbar radiculopathy: a comparison of efficacy, safety and cost"],"prefix":"10.1007","volume":"143","author":[{"given":"Jozef P. 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This study was performed in accordance with the Declaration of Helsinki principles (1964).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Due to this study\u2019s retrospective nature, as per the National Health Service Research Ethics Committee (NHS REC) decision tool, this study did not require NHS REC approval.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}