Lumbosacral radicular pain (LSRP), defined as pain arising from the lumbar spine and radiating to a lower limb, is one of the most common presentations to orthopaedic and neurosurgical outpatient clinics, with an estimated prevalence of 3–5%.1 The natural course is relatively benign – LSR pain naturally resolves partially or completely in 60 % of patients within 12 weeks.2 Where pain-congruent mechanical compression of nerve roots is identified, the underlying pathology is thought to be a complex interplay of compression, local inflammatory and immune responses, as well as the neurophysiologic response of the dorsal root ganglion to these stressors.3 In these cases, treatment pathways to address these contributing factors have been developed, inclusive of oral analgesia, physiotherapy; injection treatment and surgery.4

Injection treatment has classically been delivered as image-guided interlaminar epidural corticosteroids injection (ILSI) however this has largely been replaced by targeted Transforaminal Epidural Steroid Injection (TFESI), allowing delivery in proximity to the dorsal root ganglion (DRG),5,6 providing local control of the inflammatory component of the pain, with a potential mechanical washout effect of inflammatory mediators as a contributing therapeutic factor.7

Wilby et al. (2021) performed a randomised control trial assessing responses to TFESI compared to those undergoing discectomy.8 This found improvements in pain scores to be equivocal in both arms, with significant cost savings yielded from the implementation of TFESI as first line treatment for those presenting with LSRP.

We assess the outcomes for our clinical patient cohort undergoing TFESI, and correlate improvements in outcome scores to the size of the disc herniation. We assessed the rate of natural improvement of LSRP and the discharge rate for patients from tertiary care with a positive response to nerve root blocks.