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Pain and Spine Medicine

Lumbar Disc Features Predictive of Favorable Response to Transforaminal Epidural Steroid Injection: A Comprehensive Review

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater
Disclosure(s):
Alexander Kervyn De Volkaersbeke, MD: No financial relationships to disclose
Behnum A. Habibi, MD: No relevant disclosure to display
Sudeep Peddireddy, MD: No financial relationships to disclose
Background and/or Objectives: Lumbar disc herniation (LDH) is a prevalent condition, with transforaminal epidural steroid injections (TFESI) widely used to manage associated radicular pain. Despite its common use, the predictive value of various clinical and imaging characteristics, particularly the location of LDH, on TFESI outcomes remains unclear. This review evaluates the influence of LDH location and other imaging or clinical predictors on TFESI efficacy, hypothesizing that more lateral herniations may be associated with better treatment outcomes.

Design: A systematic review of 13 studies analyzing TFESI outcomes in patients with LDH was conducted.
Articles included patients undergoing TFESI monotherapy for pain management due to LDH. Studies assessing disc morphology, herniation location (central, paracentral, foraminal, extraforaminal), and/or nerve root compression were reviewed.

Setting : Ambulatory or Outpatient Setting.

Participants : 2776 participants across 13 studies

Interventions: no interventions: systematic review as described in design

Main Outcome Measures: Outcome measures included Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and other validated pain/disability indices.

Results: Three studies reported significantly better outcomes for lateral herniations (foraminal, extraforaminal), while six studies found no significant difference by location. Two studies suggested better outcomes in central herniations. Mild nerve compression, positive Slump test findings, and optimal TFESI technique correlated strongly with favorable outcomes. Severe nerve compression and technical challenges with more lateral herniations negatively impacted efficacy.

Conclusions: LDH location influences TFESI response, with mild compression and lateral herniations generally yielding favorable outcomes. However, technical proficiency and clinical predictors, such as positive Slump test, may be stronger determinants of success than herniation location alone. Further standardized research is required to optimize patient selection and elucidate the prognostic factors that contribute to TFESI treatment response.