Comparison of efficacy of nerve stimulation-assisted ultrasound-guided transforaminal injection versus ultrasound-guided transforaminal injection in patients with lumbar radicular pain: A Randomized Interventional Trial

The lifetime prevalence of low back and sciatic pain has been reported as 54–80% with annual prevalence ranging from 15 to 45%. Lumbar transforaminal injections (TFI) are routinely performed in the interventional management of spinal radicular pain. It provides better delivery of medication to the site of radiculopathy with minimal risk of dural puncture. Unfortunately, TFI under fluoroscopic guidance results in a rather high cumulative radiation dosage for patients and medical staff. The potential biological effects of a high x-ray dosage have deterministic and stochastic effects on skin, bone, parotid glands, and the lungs. In literature, both longitudinal and transverse approaches to perform ultrasound-guided transforaminal injection (UTFI) has been described. The different studies are inconclusive to the best approach with maximal efficacy. Nerve roots exit from the upper part of the intervertebral foramen below the pedicle. To improve the efficacy of UTFI, we hypothesized that if sensory and/or motor stimulation of nerve roots can be combined with UTFI, the efficacy of the procedure will increase.  The study will be conducted with the primary objective of comparing  Visual Analogue Scale (VAS) between the groups at the end of 1 month and  secondary objectives of comparing VAS at each time period- 30 mins, 1 week and 3 months, number of needle attempts between the two groups, contrast spread pattern and operation time between the two groups. Fourty patients will be recruited satisfying the inclusion and exclusion criteria. Patients will be divided into two group: 1. Group N: Nerve stimulation-assisted ultrasound-guided transforaminal injection and 2. Group U: Ultrasound-guided transforaminal injection. Appropriate statistical analysis would be performed after compilation of data.