Kambin triangle versus the supraneural approach for the treatment of lumbar radicular pain

OBJECTIVE: The aim of this study was to conduct a randomized, blinded, prospective outcome study on the short-term benefits of the Kambin triangle vs. the supraneural approach for the treatment of lumbar radicular pain. DESIGN: Subjects with lumbar radicular pain (n = 100) were randomly assigned to undergo transforaminal epidural steroid injection using either the Kambin triangle approach or the supraneural approach. Primary outcomes were measured with a verbal numeric pain scale and the Oswestry Disability Index, and the results at 2 and 12 wks after the procedure were compared between the groups. Secondary outcomes included patient satisfaction and the incidence of complications during the transforaminal epidural steroid injection procedure. RESULTS: For both groups, the verbal numeric pain scale and Oswestry Disability Index scores improved 2 wks after the injections, and this improvement was maintained through the 12-wk follow-up. The verbal numeric pain scale, Oswestry Disability Index, and effectiveness scores were not significantly different between groups. Neural contact occurred in nine cases with the supraneural approach; no patients experienced neural contact with the Kambin triangle approach. CONCLUSIONS: The Kambin triangle approach can be used instead of the supraneural approach in cases where it is difficult to place the needle at the anterior epidural space.ope