"Effectiveness of Physical Therapy Added to Transforaminal Injection in Lumbar Radicular Pain"

This study is designed as a single-center, prospective, observational study. Participants are patients diagnosed with lumbar disc herniation (LDH) via physical examination and magnetic resonance imaging (MRI) who present with acute radicular pain symptoms.

Intervention Groups:

Patients are divided into two groups based on their ability to participate in a physical therapy program.

Group 1 (TFESE + PT): Participants receive only ultrasound-guided TFESE.

Group 2 (TFESE Only): Participants receive ultrasound-guided transforaminal epidural steroid injection (TFESE) followed by 10 sessions of conventional physical therapy.

Both groups are provided with a standard home exercise program focusing on lumbar range of motion, core stabilization, and strengthening of abdominal and back muscles.

Injection Procedure:

The TFESE is performed under ultrasound guidance using a convex probe (3 MHz). With the patient in the prone position, the needle (22-gauge, 3.5 inch, Quincke-tip) is inserted using an in-plane approach toward the lateral aspect of the lamina. After confirming the position in both axial and parasagittal planes and performing negative aspiration, a mixture is injected. The injectate consists of 2 ml 20 mg/ml Lidocaine Hydrochloride, 1 ml Betamethasone Dipropionate/Sodium Phosphate (5 mg + 2 mg/ml), and 3 ml 0.9% Sodium Chloride.

Physical Therapy Protocol:

The physical therapy program for Group 1 consists of 10 sessions, including hot-pack application, therapeutic ultrasound, and Transcutaneous Electrical Nerve Stimulation (TENS).

Follow-up and Assessment:

Clinical evaluations and patient-reported outcomes are recorded at baseline, 1 hour post-injection, and at 1-month and 3-month follow-ups. These assessments include pain intensity (NRS), functional disability (Oswestry Disability Index), depression levels (Beck Depression Inventory), and neuropathic pain presence (DN4).

Inclusion criteria

• Patients aged between 18 and 65 years.
• Diagnosis of lumbar disc herniation confirmed by physical examination and Magnetic Resonance Imaging (MRI) within the last 6 months.
• Presence of acute radicular pain symptoms lasting more than 3 months.
• Failure to respond to conservative medical treatments (e.g., medication, rest).
• Voluntary participation and signed written informed consent.

Exclusion criteria

• History of previous lumbar spinal surgery.
• Presence of progressive motor deficits or Cauda Equina Syndrome.
• Pregnancy or breastfeeding.
• Diagnosis of malignancy, inflammatory rheumatic diseases, or neurodegenerative disorders.
• Severe obesity (Body Mass Index > 40 kg/m²).
• Known allergy to injection materials (Lidocaine, Betamethasone).
• Active local or systemic infection.
• Presence of bleeding disorders or use of anticoagulants that cannot be safely discontinued.
• Having received an epidural steroid injection or a clinical physical therapy program within the last 3 months.