Science News: Limited Benefit of TFSNRIs in Spinal Stenosis
Published May 28, 2025
Science News
Submitted by: Rebecca O'Bryan, MD
Edited by: Nakul Katyal, MD
Citation: Stephens AR, El-Hassan R, Patel RK. Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure. Arch Phys Med Rehabil. 2024;105(8):1458-1463. doi:10.1016/j.apmr.2024.02.720
Summary: The purpose of this study is to evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in patients with clinical presentation of spinal stenosis. The study was performed as a retrospective review. Participants were 176 patients with radicular leg pain in addition to 3 or more clinical features of spinal stenosis with radiological evidence of spinal stenosis on MRI. Patients with confounding spinal pathology were excluded. Patients received fluoroscopically guided transforaminal selective nerve root sleeve injections. Outcome measures were Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PR), Pain interference (PI), and Depression (D) collected at baseline, less than 3 months post procedure and 6-12 months post procedure.
In patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed in either short or long term follow up based on the PROMIS PF or Depression. However, PROMIS PI showed significant improvement in the short term follow up (however the average difference of pre and post procedure scores did not differ), with no difference in long term follow up. Overall, TFESI did not show clinically significant improvement in patient’s function, pain or depression in short or long term follow up.
Comments: This study is a retrospective analysis of multiple outcome measures evaluated by patient survey looking at the benefit of TFSNI in patients with spinal stenosis and radicular pain. The study shows no benefit in a relatively large patient sample size with this procedure. This study is in line with multiple previous studies evaluating the benefit with respect to pain of TFSNRI in this patient population. It further evaluates functional outcomes and depression as well, also showing no clinical benefit. This study is somewhat limited due to its retrospective design utilizing survey responses, which may be subject to non-response bias.