159: Real-World Outcomes of Interlaminar vs Transforaminal Epidural Injection for Lumbar Disc Herniation

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Non-pharmacological treatments

Background and Aims: Interlaminar (ILEI) and transforaminal (TFEI) epidural injections are commonly used for radicular pain in lumbar disc herniation (LDH), with prior comparative studies largely focusing on pain relief and functional outcomes. However, outcomes that may influence real-world treatment pathway selection, such as quality of life, treatment burden, and economic cost, remain insufficiently addressed. This study aimed to compare ILEI and TFEI in patients with LDH from a real-world clinical perspective, incorporating patient-centred and decision-relevant outcomes to better inform individualized pathway selection.

Methods: This single-center retrospective cohort study included patients with lumbar disc herniation who underwent epidural injection between January 2021 and September 2023. Patients were categorized into interlaminar (ILEI) and transforaminal (TFEI) groups based on the injection approach. Both groups received dexamethasone palmitate combined with 0.25% lidocaine. Clinical outcomes were assessed at baseline and at 1, 3, and 6 weeks post-treatment via medical records and telephone follow-up. The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS). Secondary outcomes included the Oswestry Disability Index (ODI), modified MacNab criteria, SF-36 quality-of-life scores, analgesic discontinuation rate, adverse events, and total treatment cost.

Results: A total of 98 patients completed the 6-week follow-up (ILEI: n=50; TFEI: n=48). Both groups showed significant improvement in pain intensity (NRS), ODI, and SF-36 scores at all post-treatment time points compared with baseline (p<0.05). TFEI resulted in significantly lower NRS scores at 1, 3, and 6 weeks (p<0.05), whereas ODI scores and modified MacNab outcomes were comparable between groups. At 6 weeks, TFEI demonstrated significantly higher scores in several SF-36 domains, including physical and mental component summaries (p<0.05). Analgesic discontinuation and adverse event rates were similar, while treatment costs were significantly higher in the TFEI group (p<0.001).

Conclusions: TFEI provided superior short-term pain relief and greater improvement in health-related quality of life compared with ILEI in patients with LDH. While functional outcomes and tolerability were comparable, TFEI was associated with higher treatment cost. These findings incorporating patient-reported outcomes and cost data may inform individualized pathway selection in real-world clinical decision-making.

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Presenting Author: Ming Wei
Submitting Author: Ming Wei

Senior Author: Xia Feng

IASP 2026 Global Year theme of Neuropathic Pain: Yes