{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:32:45Z","timestamp":1787009565449,"version":"build-2736575974"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Transforaminal epidural steroid injection (TFESI) is a prevalent treatment modality for lumbosacral radicular pain caused by disc herniation; however, the impact of varying disc morphologies on treatment outcomes remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effects of TFESI on pain and disability across different lumbar disc morphologies using the Michigan State University (MSU) classification system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A single center pain management clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and Intervention<\/jats:title>\n                    <jats:p>A total of 168 patients with single-level lumbar disc herniation at L4-L5 or L5-S1 treated with TFESI. Patients were divided into 7 subgroups according to the MSU classification based on MRI findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The numerical rating scale (NRS) for pain and Oswestry Disability Index (ODI) for assessing disability were measured at baseline, 1-month and 3-months post-procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TFESI significantly reduced NRS and ODI scores in all groups (P\u2009&amp;lt;\u2009.001). At 1-month follow-up, NRS scores of group 1B were significantly lower than those of groups 2A and 2AB (P\u2009&amp;lt;\u2009.001 and P\u2009=\u2009.020, respectively); at the 3-month follow-up, no differences were observed between the groups. Although ODI scores improved over time, they did not exhibit significant differences among the subgroups throughout the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>TFESI effectively reduces pain and disability across varying disc morphologies. At the 1-month mark, pain relief was more pronounced in group 1B compared to 2A and 2AB groups, whereas at the 3-month mark, the results were similar between subgroups. Larger studies with longer follow-up are needed to improve patient selection criteria and optimize treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnaf040","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T07:43:24Z","timestamp":1743493404000},"page":"440-450","source":"Crossref","is-referenced-by-count":2,"title":["Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0502-3389","authenticated-orcid":false,"given":"Tuba","family":"Tanyel Sara\u00e7o\u011flu","sequence":"first","affiliation":[{"name":"Pain Management Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Erken","sequence":"additional","affiliation":[{"name":"Pain Management Clinic, Basaksehir Cam and Sakura City Hospital, Istanbul 34480,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"issue":"3","key":"2025080103520469600_pnaf040-B1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/papr.13317","article-title":"1. Lumbosacral radicular pain","volume":"24","author":"Peene","year":"2024","journal-title":"Pain Pract"},{"key":"2025080103520469600_pnaf040-B2","first-page":"1118","article-title":"Herniated lumbar disc","volume":"2011","author":"Jordan","year":"2011","journal-title":"BMJ Clin Evid"},{"issue":"10294","key":"2025080103520469600_pnaf040-B3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/S0140-6736(21)00733-9","article-title":"Low back pain","volume":"398","author":"Knezevic","year":"2021","journal-title":"Lancet"},{"issue":"1","key":"2025080103520469600_pnaf040-B4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.spinee.2017.08.264","article-title":"A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation","volume":"18","author":"Kennedy","year":"2018","journal-title":"Spine J"},{"issue":"5","key":"2025080103520469600_pnaf040-B5","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1111\/papr.13351","article-title":"Pulsed radiofrequency of lumbar dorsal root ganglion for lumbar radicular pain: a systematic review and meta-analysis","volume":"24","author":"Park","year":"2024","journal-title":"Pain Pract"},{"issue":"4","key":"2025080103520469600_pnaf040-B6","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s40122-023-00508-y","article-title":"Efficacy of percutaneous adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"Manchikanti","year":"2023","journal-title":"Pain Ther"},{"issue":"5","key":"2025080103520469600_pnaf040-B7","first-page":"978","article-title":"Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy","volume":"27","author":"Cyteval","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"issue":"2","key":"2025080103520469600_pnaf040-B8","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1148\/radiol.2452062007","article-title":"Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective randomized controlled study","volume":"245","author":"Jeong","year":"2007","journal-title":"Radiology"},{"issue":"8","key":"2025080103520469600_pnaf040-B9","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1111\/pme.12122","article-title":"Clinical effectiveness of single lumbar transforaminal epidural steroid injections","volume":"14","author":"Kaufmann","year":"2013","journal-title":"Pain Med"},{"issue":"1","key":"2025080103520469600_pnaf040-B10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.36076\/ppj\/2015.18.79","article-title":"A randomized, double-blind controlled trial of lumbar interlaminar epidural injections in central spinal stenosis: 2-year follow-up","volume":"18","author":"Manchikanti","year":"2015","journal-title":"Pain Physician"},{"issue":"9","key":"2025080103520469600_pnaf040-B11","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/PHM.0000000000000730","article-title":"The 1-year results of lumbar transforaminal epidural steroid injection in patients with chronic unilateral radicular pain: the relation to MRI findings and clinical features","volume":"96","author":"Ekedahl","year":"2017","journal-title":"Am J Phys Med Rehabil"},{"issue":"1","key":"2025080103520469600_pnaf040-B12","first-page":"126","article-title":"Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica","volume":"50","author":"\u015eencan","year":"2020","journal-title":"Turk J Med Sci"},{"issue":"4","key":"2025080103520469600_pnaf040-B13","first-page":"645","article-title":"Role of magnetic resonance imaging in ascertaining the success of transforaminal epidural steroid injection for lumbar radicular pain","volume":"18","author":"Tecer","year":"2017","journal-title":"Pain Med"},{"issue":"7","key":"2025080103520469600_pnaf040-B14","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00586-009-1274-4","article-title":"MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection","volume":"19","author":"Mysliwiec","year":"2010","journal-title":"Eur Spine J"},{"issue":"12","key":"2025080103520469600_pnaf040-B15","first-page":"e50257","article-title":"Functional outcomes and successful predictors of lumbar transforaminal epidural steroid injections (ltfesis) for lumbar radiculopathy under fluoroscopic guidance: a prospective study","volume":"15","author":"Dhandapani","year":"2023","journal-title":"Cureus"},{"issue":"5","key":"2025080103520469600_pnaf040-B16","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/01.BRS.0000113869.13209.03","article-title":"Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain","volume":"29","author":"Yakut","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"2025080103520469600_pnaf040-B17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1590\/1413-785220182606201444","article-title":"Reliability of the Michigan State University (MSU) classification of lumbar disc herniation","volume":"26","author":"Kaliya-Perumal","year":"2018","journal-title":"Acta Ortop Bras"},{"issue":"9","key":"2025080103520469600_pnaf040-B18","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/j.apmr.2024.01.002","article-title":"Comparison of particulate steroid injection vs nonparticulate steroid injection for lumbar radicular pain: a systematic review and meta-analysis","volume":"105","author":"Kim","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"2025080103520469600_pnaf040-B19","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s10143-017-0826-z","article-title":"The short and midterm outcomes of lumbar transforaminal epidural injection with preganglionic and postganglionic approach in lumbosacral radiculopathy: a systematic review and meta-analysis","volume":"41","author":"Pairuchvej","year":"2018","journal-title":"Neurosurg Rev"},{"issue":"1","key":"2025080103520469600_pnaf040-B20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/1591019918800458","article-title":"Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification","volume":"25","author":"Hosseini","year":"2019","journal-title":"Interv Neuroradiol"},{"issue":"2","key":"2025080103520469600_pnaf040-B21","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"issue":"1","key":"2025080103520469600_pnaf040-B22","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/BRS.0b013e31815e3a10","article-title":"Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change","volume":"33","author":"Ostelo","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"2025080103520469600_pnaf040-B23","doi-asserted-by":"crossref","first-page":"466","DOI":"10.14444\/8068","article-title":"Prognostic value of Michigan State University (MSU) classification for lumbar disc herniation: is it suitable for surgical selection?","volume":"15","author":"d'Ercole","year":"2021","journal-title":"Int J Spine Surg"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnaf040\/62844119\/pnaf040.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/26\/8\/440\/62844119\/pnaf040.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/26\/8\/440\/62844119\/pnaf040.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T07:52:13Z","timestamp":1754034733000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/26\/8\/440\/8104056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":23,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4,2]]},"published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnaf040","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,4,2]]}}}