4. Discussion
intervertebral disc herniation, Pain, herniation, subarticular hernia, hernia, NRI, pain, Morris Disability, hernias, disability, lumbar radicular pain
SECONDARY, INTERVERTEBRAL DISC HERNIATION, NERVE ROOT COMPRESSION
The aim of this study was to examine the effectiveness of ESI TF in patients with lumbar radicular pain caused by intervertebral disc herniation, depending on the presence of discoradicular contact or not. Pain intensity was measured by the VAS, and the degree of disability was measured by the ODI.In this study, the median age of participants was 49 years, most participants had a secondary education (75%), and a large proportion were on sick leave (34%). These results align with other research confirming that lumbar radicular pain most often affects the working population and represents a significant economic problem due to work disability and sick leave [MRI findings do not always correlate with the clinical picture or treatment outcome after ESI, thus there is a need to identify factors so that patients and doctors can know what treatment outcome they can expect. Numerous factors have been studied as possible predictors of treatment outcomes. Serum markers and MRI findings have been studied the most often [The results obtained in this study align with the research by Tecer et al., who examined MR findings as predictors of treatment outcomes. In addition to the contact itself, the type of hernia (bulging, protruding, extruding), hernia location (central, subarticular, foraminal, extraforaminal), high-intensity zone (HIZ), and nerve root impingement (NRI) were observed. The median age of the participants was similar to that in our study (45.3 ± 12.5 years), as well as the most affected segment (L5/S1). Among all participants, there was a statistically significant reduction in pain intensity by at least 50% in 42% of participants after 2 weeks and in 56% of participants after 3 months. During the follow-up period, there were no significant differences in reduced pain intensity depending on the type and location of the hernia. In participants with nerve root compression, the success rate was higher but not statistically significant [In a Korean study, there was no significant difference between responders and nonresponders based on the type and size of the hernia. The location of the hernia and the degree of nerve root compression proved to be good predictors of treatment outcome. Specifically, participants with central and extraforaminal hernias had better treatment outcomes, while those with a subarticular hernia had worse treatment outcomes. Those with a lower degree of compression had a more painful treatment outcome than those with a higher degree of compression [In patients with a lower degree of compression, it is considered that the main pathophysiological mechanism of pain is the local inflammatory process, which is why ESI is effective. It is less effective in patients with a higher degree of compression, but even then the inflammatory component should not be ignored. The effectiveness of ESI TF, defined as a reduction in pain by at least 50% in all participants, was found in 53.5% of cases. No correlation was observed between efficacy and location and type of hernia [In a study by Kaufmann et al., the results showed that the effectiveness of ESI TF after 2 weeks was 40.9% and after 2 months was 45.6%, as measured by the Roland–Morris Disability Questionnaire [In a study by Rados et al., in which the patients were not divided into groups according to whether there was contact of the disc herniation and the nerve root, the initial disability was 53%, while it was 38% after 6 months [The literature reports varying rates of effectiveness of ESI TF. It is not equally effective in all patients, so there is a need to identify clinical, radiological, and other predictors to determine which patients will benefit.