{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:11Z","timestamp":1760146871735,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T00:00:00Z","timestamp":1734739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p &gt; 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success.<\/jats:p>","DOI":"10.3390\/jcm13247821","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T10:58:55Z","timestamp":1734951535000},"page":"7821","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Caudal Epidural Steroid Injection on Transforaminal Epidural Steroid Injection and Dorsal Root Ganglion Pulsed Radiofrequency in Recurrent Lumbar Disc Herniation"],"prefix":"10.3390","volume":"13","author":[{"given":"G\u00fcl\u00e7in.","family":"Gazio\u011flu T\u00fcrky\u0131lmaz","sequence":"first","affiliation":[{"name":"Pain Clinic, Bursa City Hospital, Bursa 16110, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7042-6934","authenticated-orcid":false,"given":"\u015eebnem.","family":"Rumeli","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology and Reanimation, Mersin University Faculty of Medicine, Mersin 33240, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3627-3882","authenticated-orcid":false,"given":"Mesut.","family":"Bak\u0131r","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology and Reanimation, Mersin University Faculty of Medicine, Mersin 33240, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2397-0179","authenticated-orcid":false,"given":"Suna.","family":"A\u015fk\u0131n Turan","sequence":"additional","affiliation":[{"name":"Pain Clinic, Mersin City Education and Research Hospital, Mersin 33343, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hao, L., Li, S., Liu, J., Shan, Z., Fan, S., and Zhao, F. (2020). Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present. J. Orthop. Surg. Res., 15.","DOI":"10.1186\/s13018-020-01695-6"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/00007632-200103150-00024","article-title":"Recurrent lumbar disc herniation: Results of operative management","volume":"26","author":"Suk","year":"2001","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00264-008-0531-1","article-title":"Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion","volume":"33","author":"Chen","year":"2009","journal-title":"Int. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Evran, S., Kayhan, A., Baran, O., Saygi, T., Katar, S., Akkaya, E., Ozbek, M.A., and \u00c7evik, S. (2021). The Synergistic Effect of Combined Transforaminal and Caudal Epidural Steroid Injection in Recurrent Lumbar Disc Herniations. Cureus, 13.","DOI":"10.7759\/cureus.12538"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.4184\/asj.2014.8.5.646","article-title":"Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation","volume":"8","author":"Karamouzian","year":"2014","journal-title":"Asian Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Um, M.K., Lee, E., Lee, J.W., Kang, Y., Ahn, J.M., and Kang, H.S. (2022). Fluoroscopic lumbar transforaminal epidural steroid injections for recurrent herniated intervertebral disc after discectomy: Effectiveness and outcome predictors. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0271054"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/pme.12624","article-title":"Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: A randomized controlled study","volume":"16","author":"Koh","year":"2015","journal-title":"Pain Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Munjupong, S., Tontisirin, N., and Finlayson, R.J. (2016). The effect of pulsed radiofrequency combined with a transforaminal epidural steroid injection on chronic lumbar radicular pain: A randomized controlled trial. Adv. Anesthesiol., 2016.","DOI":"10.1155\/2016\/2136381"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.55730\/1300-0144.5429","article-title":"Factors associated with treatment success after combined transforaminal epidural steroid injection and dorsal root ganglion pulsed radiofrequency treatment in patients with chronic lumbar radicular pain","volume":"52","year":"2022","journal-title":"Turk. J. Med. Sci."},{"key":"ref_10","first-page":"29","article-title":"Sample size determination and power analysis in clinical trials","volume":"3","year":"2011","journal-title":"J. Turk. Soc. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"110","DOI":"10.4103\/jcvjs.jcvjs_38_22","article-title":"Incidence of recurrent lumbar disc herniation: A narrative review","volume":"13","author":"Mariscal","year":"2022","journal-title":"J. Craniovertebral Junction Spine"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Swartz, K.R., and Trost, G.R. (2003). Recurrent lumbar disc herniation. Neurosurg. Focus, 15.","DOI":"10.3171\/foc.2003.15.3.10"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Huang, W., Han, Z., Liu, J., Yu, L., and Yu, X. (2016). Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine, 95.","DOI":"10.1097\/MD.0000000000002378"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E786","DOI":"10.1503\/cmaj.171333","article-title":"Anticonvulsants in the treatment of low back pain and lumbar radicular pain: A systematic review and meta-analysis","volume":"190","author":"Enke","year":"2018","journal-title":"Cmaj"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"480","DOI":"10.7326\/M16-2458","article-title":"Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline","volume":"166","author":"Chou","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s40266-022-00946-x","article-title":"Pharmacotherapy for Spine-Related Pain in Older Adults","volume":"39","author":"Fu","year":"2022","journal-title":"Drugs Aging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/01616412.2022.2116525","article-title":"Factors associated with the recurrence of lumbar disk herniation: Non-biomechanical-radiological and intraoperative factors","volume":"45","author":"Abdallah","year":"2023","journal-title":"Neurol. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1177\/2192568217745063","article-title":"Recurrent Lumbar Disc Herniation: A Review","volume":"9","author":"Shepard","year":"2019","journal-title":"Global Spine J."},{"key":"ref_20","first-page":"S27","article-title":"Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines","volume":"24","author":"Manchikanti","year":"2021","journal-title":"Pain Physician"},{"key":"ref_21","first-page":"124","article-title":"The efficacy of pulsed radiofrequency intervention of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain","volume":"75","author":"Marliana","year":"2020","journal-title":"Med. J. Malaysia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7821\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:57:24Z","timestamp":1760115444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,21]]},"references-count":21,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247821"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247821","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,12,21]]}}}