Comparison of efficacy, accuracy, and safety between axial and sagittal approaches of ultrasound guided transforaminal epidural injection for lumbar radiculopathy: A randomized controlled trial.

Abstract

Objective: To compare the clinical efficacy, parameters of intervention, and safety of axial versus sagittal ultrasound-guided TFESIs in patients with Lumbar radiculopathy. Study Design: Prospective Randomized Controlled Trial. Setting: Department of Anaesthesia and Pain Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: August 2025 and January 2026. Methods: Including 88 patients (44 in each group) diagnosed with Lumbar radiculopathy were enrolled in this trial and were randomly assigned by a lottery system to undergo either axial or sagittal US-guided TFESIs. The primary outcomes were measured at baseline, 2 weeks, 1 month, and 3 months. Secondary outcomes included procedure time and fluoroscopically confirmed accuracy and adverse effects. Results: Both groups demonstrated significant improvements in VAS and ODI (p < 0.001). The sagittal approach also had significantly reduced VAS at 2 weeks (3.8 ± 0.9 vs. 4.2 ± 1.1; p = 0.042) and 1 month (2.8 ± 0.8 vs. 3.1 ± 0.9; p = 0.038). The ODI was also significantly reduced for the sagittal approach compared with the axial approach at 2 weeks (p < 0.001) and 1 month (p < 0.001). The sagittal approach was also faster than the axial approach (10.2 ± 1.8 min vs. 15.4 ± 2.5 min; p < 0.001). The accuracy was comparable between the two approaches: sagittal, 95.5%, axial, 90.9%. Conclusion: The two US-guided approaches are safe and effective. The sagittal approach is superior in terms of procedural efficiency and short-term clinical outcomes for the lumbar TFESI.