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Kambin Triangle Versus the Supraneural Approach for the Treatment of Lumbar Radicular Pain

Park, Ki Deok MD; Lee, Jiwon MD; Jee, Heami MS; Park, Yongbum MD

American Journal of Physical Medicine & Rehabilitation: December 2012 - Volume 91 - Issue 12 - p 1039–1050
doi: 10.1097/PHM.0b013e318264573a
Original Research Articles

Objective The aim of this study was to conduct a randomized, blinded, prospective outcome study on the short-term benefits of the Kambin triangle vs. the supraneural approach for the treatment of lumbar radicular pain.

Design Subjects with lumbar radicular pain (n = 100) were randomly assigned to undergo transforaminal epidural steroid injection using either the Kambin triangle approach or the supraneural approach. Primary outcomes were measured with a verbal numeric pain scale and the Oswestry Disability Index, and the results at 2 and 12 wks after the procedure were compared between the groups. Secondary outcomes included patient satisfaction and the incidence of complications during the transforaminal epidural steroid injection procedure.

Results For both groups, the verbal numeric pain scale and Oswestry Disability Index scores improved 2 wks after the injections, and this improvement was maintained through the 12-wk follow-up. The verbal numeric pain scale, Oswestry Disability Index, and effectiveness scores were not significantly different between groups. Neural contact occurred in nine cases with the supraneural approach; no patients experienced neural contact with the Kambin triangle approach.

Conclusions The Kambin triangle approach can be used instead of the supraneural approach in cases where it is difficult to place the needle at the anterior epidural space.

From the Department of Rehabilitation Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon (KDP); Department of Family Medicine, Severance College of Medicine Yonsei University, Seoul (JL); Department of Medical Science, University of Ulsan College of Medicine, Seoul (HJ); and Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea (YP).

All correspondence and requests for reprints should be addressed to: Yongbum Park, Sanggye Paik Hospital, Inje University College of Medicine, 761-1, Sanggye-dong, Nowon-gu, Seoul 139-707, Republic of Korea.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2012 Lippincott Williams & Wilkins, Inc.