We evaluated the effects of combination of a transforaminal nerve root block and an epidural block using corticosteroid and local anesthetics, for the management of radiating pain to the lower extremities.

Thirty patients who suffered from chronic radiating pain that resistant conservative treatments including epidural steroid injection (ESI) were enrolled. Following a transforaminal nerve root block under fluoroscopic visualization, an ESI was administered at the level of the intervertebral space showing an obstacle to cephalad epidural spread of the dye injected during a transforaminal nerve root block. Twenty to forty mg of triamcinolone with 0.5% lidocaine was injected in divided doses. The patients received these nerve blocks at intervals of 1 2 weeks until the patients were satisfied with the results. If the pain reappeared, repeated blocks were administered at intervals of 2 months. Treatment results were evaluated twice using a pain relief scale and categorized as excellent, good, fair, or poor.

Pain improvements of more than 50% of the initial pain intensity, graded excellent or good, were observed in 66.7% at 1 week after the 1st blocks and 73.3% at 3 months after the final blocks.

These findings suggest that a combination of a transforaminal nerve root block and ESI is an effective procedure for radiating pain not responding to ESI. However, comparative prospective studies to determine the effects of this combination therapy versus classical transforaminal injections may be mandatory.