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Pain and Spine Medicine

Are Lumbar Transforaminal Epidural Steroid Injections More Effective When Treating Unilateral or Bilateral Radicular Leg Pain

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 10
Disclosure(s):
Isabel S. Clauss-Ehlers, Other: No financial relationships to disclose
Zeinab Mohamed, PhD: No financial relationships to disclose
Ali Shakir, MD: No financial relationships to disclose
Background and/or Objectives: To determine if the pain score reduction following a lumbar transforaminal epidural steroid injection (TFESI) for the management of lumbar radicular leg pain is different for subjects with unilateral radicular leg pain, as compared to subjects with bilateral radicular leg pain.

Design: This was a retrospective cohort study of subjects with lumbar radiculopathy who underwent lumbar TFESI under fluoroscopic guidance to address either unilateral or bilateral radicular leg pain. The data was divided into two groups, those with unilateral radicular leg pain and those with bilateral radicular leg pain. One-way ANOVA analysis was used to compare these 2 groups with regard to their numerical pain score reduction 1 month after procedure.

Setting : All procedures were performed under fluoroscopic guidance in a single community-based physical medicine and rehabilitation clinic.

Participants : Patients who underwent their first 2 level unilateral or 1 level bilateral lumbar TFESI under fluoroscopic guidance for the management of radicular leg pain from 08/01/2022 through 08/31/2024.

Interventions: not applicable

Main Outcome Measures: Numerical pain score reduction 1 month after lumbar TFESI.

Results: From 08/01/2022 through 08/31/2024, 496 subjects underwent their first lumbar TFESI: 127 bilateral and 369 unilateral. The bilateral TFESI had a mean pre-procedure pain score of 7.17 (SD=1.38 and a mean reduction of 2.92 (SD=1.80). Unilateral TFESI had a mean pre-procedure pain score of 6.81 (SD=1.59) and a mean reduction of 2.76 (SD=1.79). One-way ANOVA found no significant difference in pain reduction between 2 level unilateral and 1 level bilateral TFESI (F(1,496) = 1.036, p = 0.309).

Conclusions: No significant difference in numeric pain score reduction 1 month after procedure was seen between a 2 level unilateral TFESI and a 1 level bilateral TFESI in the management of lumbar radicular leg pain.