The Role of Diagnostic Targeted Epidural Injection in the Diagnosis and Management of Chronic Spinal Pain: A Retrospective Analysis on 99 Patients.

Abstract

Background: Chronic spinal pain, led by low back pain (LBP), which affects 619 million people globally and is projected to reach 843 million by 2050, is the main cause of disability. Although epidural steroid injections (ESIs) are recommended at Level I-A, their efficacy is often limited by technical factors, such as scarring, and they provide incomplete diagnostic information. We propose diagnostic targeted epidural injection (dTEI) via a Racz catheter, focused on detailed epidurography and anatomical exploration, as an essential diagnostic-therapeutic triage tool to overcome these drawbacks.

Objectives: The objective of this study is to evaluate the efficacy of the procedure in a mixed low back pain population.

Methods: A retrospective analysis was conducted on 99 patients with chronic radiculopathy, LBP, Post-Spine Surgery Syndrome type 2 (PSPS-2), or spinal stenosis (VAS > 40, duration > 3 months) treated with dTEI between January and December 2023. Outcomes, including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Quality of Life (QoL), and opioid use (morphine equivalent dose), were evaluated at one-month follow-up. Success was defined as either a VAS reduction greater than 50% or achievement of the Minimum Clinically Important Difference (MCID).

Results: The mean age was 67.57 years. Significant improvements were observed in VAS scores (from 78.18 to 57.88, P < 0.001) and QoL scores (from 45.33 to 51.62, P = 0.001). Minimal therapeutic success according to MCID was achieved by 59.6% of patients. Opioid consumption was significantly reduced by 38%. Subgroup analysis showed that the spinal stenosis group achieved the best outcomes across all metrics. No correlation was found between the surgeon's subjective assessment of technical success (contrast runoff/defect reduction) and superior clinical outcome.

Conclusions: Diagnostic targeted epidural injection serves as a valuable diagnostic tool with significant therapeutic potential, optimizing patient selection in a stepwise management pathway. It effectively reduces pain and opioid use and provides detailed anatomical information to selectively guide nonresponders toward more complex and costly therapies, such as spinal cord stimulation or epiduroscopy. The primary value of the technique lies in diagnostic clarification and refinement of the therapeutic trajectory.