COMPARISON OF CLINICAL EFFICACY OF TRANSFORAMINALEPIDURAL STEROID INJECTION VIA KAMBIN'STRIANGLEVERSUS CLASSICAL SAFE TRIANGLE APPROACHINLUMBARDISC HERNIATION WITH RADICULOPATHY

Abstract

Background: Lumbar disc herniation with radiculopathy is a major cause of chronic low back pain and lower limb disability, often resulting in significant functional impairment and reduced quality of life. Transforaminal epidural steroid injection (TFESI) is a well-established minimally invasive treatment for patients who do not respond to conservative therapy. Although the classical safe triangle approach has been widely adopted, concerns regarding neural irritation and vascular injury have prompted the use of alternative techniques such as the Kambin's triangle approach. Aim: To compare the clinical efficacy and procedural safety of TFESI performed using the Kambin's triangle approach and the classical safe triangle approach in patients with lumbar disc herniation associated with unilateral radiculopathy. Materials and Methods: This prospective randomized comparative study included 50 patients with MRI-confirmed lumbar disc herniation and unilateral radiculopathy. Patients were randomly allocated into two equal groups (n=25 each). Group A underwent TFESI using the classical safe triangle approach, whereas Group B received TFESI through the Kambin's triangle approach. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional disability was evaluated using the Oswestry Disability Index (ODI). Clinical assessments were performed before the procedure and at 2 weeks, 1 month, and 3 months after injection. Procedural complications, including nerve root irritation, paresthesia, intravascular uptake, and post-procedural pain flare, were also recorded. Statistical analysis was performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered statistically significant. Results: Both groups demonstrated significant reductions in VAS scores and improvements in ODI scores during follow-up, indicating effective pain relief and functional recovery following TFESI. However, patients treated using the Kambin's triangle approach showed greater improvement in pain and disability scores at later follow-up visits. Furthermore, the incidence of procedure-related complications, including nerve root irritation, intravascular uptake, paresthesia, and post-procedural pain flare, was lower in the Kambin group, indicating superior procedural safety and better patient tolerance. Conclusion: Both the classical safe triangle and Kambin's triangle approaches are effective techniques for transforaminal epidural steroid injection in patients with lumbar disc herniation and radiculopathy. However, the Kambin's triangle approach offers comparable clinical efficacy with a lower complication rate and improved procedural safety. It may therefore be considered a preferable alternative to the conventional safe triangle technique for fluoroscopy-guided TFESI.