A comparative study of ultrasound-guided versus fluoroscopy-guided transforaminal epidural steroid injection in lumbar radiculopathy: Efficacy, safety, and radiation exposure.

Objective: Transforaminal epidural steroid injection is the most used intervention as minimally invasive non-surgical management of lumbar radiculopathy. While fluoroscopy guidance remains the traditional gold standard, ultrasound guidance has also gained popularity. This study compares the efficacy, safety, and radiation exposure of ultrasound-guided versus fluoroscopy-guided TFESI. Study Design: Prospective, Single Blind, Randomized Controlled Trial. Setting: Department of Anesthesia and Pain Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: August 2025 to January 2026. Methods: 88 patients (44 per group) diagnosed with unilateral lumbar radiculopathy. Group A received fluoroscopy-guided TFESI (FG), and Group B received ultrasound-guided TFESI (USG) with fluoroscopic confirmation. Outcome were assessed at baseline, 1 week, 4 weeks, and 12 weeks; radiation dose (mGy); fluoroscopy time (seconds); and procedure duration (minutes). Results: Significant improvements in VAS and ODI were observed in both groups from baseline, with no significant differences between groups at 12 weeks (p < 0.001) (VAS: USG 2.4 ± 1.1 vs. FG 2.3 ± 1.2, p = 0.68). Radiation exposure and Mean fluoroscopy time were significantly lower in the USG group (0.27 ± 0.10 mGy vs 3.45 ± 0.65 mGy, p < 0.001, and 0.17 ± 0.07 s vs. 52.91 ± 13.91 s, p < 0.001, respectively). No major complications occurred in either group. Conclusion: Ultrasound-guided TFESI is an effective and radiation-free alternative to fluoroscopy-guided TFESI in the treatment of lumbar radiculopathy.