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Background and Aims Transforaminal Epidural Steroid Injection (TFESI) is widely utilized and highly effective in alleviating radicular back pain. Despite numerous studies exploring predictive factors for TFESI treatment outcomes, there is no data on the association between facet joint degeneration and TFESI efficacy. This study aims to study the impact of facet joint degeneration on TFESI treatment outcomes for unilateral radicular pain.

Methods A retrospective analysis was conducted on patients with unilateral radicular pain who underwent lumbosacral TFESI between January 2021 and September 2023 at a university hospital. Pain severity was assessed using the Numerical Rating Scale (NRS) at baseline, 1 hour post-procedure, and 3 weeks post-procedure. Degree of facet joint degeneration was evaluated via MRI using the Weishaupt staging system. Patients were categorized into two groups: those with Weishaupt grade 0 and 1 comprised the low-grade facet joint degeneration group (Group 1), while those with grade 2 and 3 were classified into the high-grade facet joint degeneration group (Group 2).

Results A total of 147 patients were included in the study. Both Group 1 (n=88) and Group 2 (n=59) exhibited a statistically significant decrease in NRS scores at all post-procedural follow-ups. Notably, at the 3-week post-procedure assessment, NRS scores were significantly higher in Group 2 (p<0.01). Treatment success, defined as a ≥50% reduction in NRS scores, was significantly higher in low-grade facet degeneration group (p<0.01).

Conclusions Facet joint degeneration adversely impacts the treatment success of TFESI. Hence, a comprehensive evaluation of facet joint pathologies prior to procedure planning is imperative for optimizing treatment outcomes.