{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:31:18Z","timestamp":1786649478280,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"\n Background:<\/jats:title>\n Epidural steroid injection (ESI) is a minimally invasive treatment for lumbar disc herniation (LDH). It can be applied using a transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), or combined (TFESI + CESI) approach.<\/jats:p>\n <\/jats:sec>\n \n Aim:<\/jats:title>\n To compare the effectiveness of the three ESI approaches and the combined ESI application in reducing pain in patients with single or multi-level LDH.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n In this retrospective study, we included 239 patients diagnosed with LDH (who complained of low back pain for at least 3 months, had no neurological deficit or history of lumbar surgery, and were not contraindicated for ESI application) who received ESI and were followed up clinically for 2 years. Demographic (age, sex, body mass index (BMI)) and clinical data (duration of low back pain, visual analog scale (VAS) scores before and after ESI, and procedure-related information) were obtained from medical records. The VAS scores noted before treatment and at 3 months, 1 year, and 2 years after ESI were compared.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The post-treatment VAS scores of the combined ESI (TFESI + CESI) group were significantly lower than those of other approaches applied alone (\n P<\/jats:italic>\n < 0.05). Furthermore, VAS scores of the ILESI and CESI groups were significantly lower than those of the TFESI group at all three post-treatment time points (\n P<\/jats:italic>\n < 0.05). The patient\u2019s age and BMI were weakly correlated with the post-treatment VAS scores.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Combined ESI is more effective than any single-approach ESI in LDH and should be considered in suitable patients to increase treatment effectiveness.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/njcp.njcp_47_24","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T23:00:51Z","timestamp":1730329251000},"page":"1135-1140","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of the Results of Combined Epidural Steroid Injection with Other Approaches in Lumbar Disc Herniation: A Retrospective Study"],"prefix":"10.4103","volume":"27","author":[{"given":"MO","family":"Y\u00fcksel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medipol University Faculty of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Kolutek Ay","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Kahramanmara\u015f Necip Faz\u0131l City Hospital, Kahramanmara\u015f, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Besnek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u015eanl\u0131urfa Training and Research Hospital, \u015eanl\u0131urfa, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Erdogan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u015eanl\u0131urfa Training and Research Hospital, \u015eanl\u0131urfa, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"R1-20260427","doi-asserted-by":"crossref","first-page":"231.","DOI":"10.3390\/ijerph19010231","article-title":"Epidural steroid injections for low back pain: A narrative review","volume":"19","author":"Carassiti","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"R2-20260427","article-title":"Epidural Steroid Injections","author":"Patel","year":"2023","journal-title":"Treasure Island (FL), StatPearls;"},{"key":"R3-20260427","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.pmr.2022.01.009","article-title":"Epidural steroid injections","volume":"33","author":"William","year":"2022","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"R4-20260427","first-page":"e12538.","article-title":"The synergistic effect of combined transforaminal and caudal epidural steroid injection in recurrent lumbar disc 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herniations","volume":"9","author":"Schaufele","year":"2006","journal-title":"Pain Physician"},{"key":"R11-20260427","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1007\/s00256-023-04290-y","article-title":"Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: Prospective study of 237 patients with unilateral radicular pain and up to 5 years of follow-up","volume":"52","author":"Bise","year":"2023","journal-title":"Skeletal Radiol"},{"key":"R12-20260427","doi-asserted-by":"crossref","first-page":"S314","DOI":"10.4103\/ija.ija_349_22","article-title":"Comparative evaluation of midline versus parasagittal interlaminar epidural steroid injection for management of symptomatic lumbar intervertebral disc herniation","volume":"66","author":"Kumar","year":"2022","journal-title":"Indian J Anaesth"},{"key":"R13-20260427","doi-asserted-by":"crossref","first-page":"e3373.","DOI":"10.1097\/MD.0000000000003373","article-title":"The effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain: A systematic review and meta-analysis","volume":"95","author":"Liu","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"R14-20260427","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1093\/pm\/pnad041","article-title":"Caudal epidural steroid injection versus transforaminal ESI for unilateral S1 radiculopathy: A prospective, randomized trial","volume":"24","author":"Ozturk","year":"2023","journal-title":"Pain Med"},{"key":"R15-20260427","doi-asserted-by":"crossref","first-page":"634.","DOI":"10.12688\/f1000research.23188.1","article-title":"Effect of supraneural transforaminal epidural steroid injection combined with caudal epidural steroid injection with catheter in chronic radicular pain management: Double blinded randomized controlled 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