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Comparison of epidural space contrast flow and clinical outcomes in parasagittal versus transforaminal epidural steroid injection
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  • Published: 03 February 2026

Comparison of epidural space contrast flow and clinical outcomes in parasagittal versus transforaminal epidural steroid injection

  • Narges Khojasteh1,2,
  • Hossein Majedi3,7,
  • Ali Emami Meibodi3,
  • Alireza Khajehnasiri3,4,
  • Reza Atef Yekta3,4,
  • Nader Ali Nazemian Yazdi3,5,
  • Mojgan Rahimi3,
  • Sogol Alikarami3,
  • Koorosh Kamali6 &
  • …
  • Hamed Abdollahi5 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Chronic pain
  • Neuropathic pain
  • Pain

Abstract

Epidural steroid injections (ESI) are frequently used to treat lumbosacral radicular pain, but the solute spread in the epidural space needs further investigation. This semi-blind, randomized study assessed clinical outcomes and contrast spread patterns between the parasagittal interlaminar (PIL) and transforaminal (TF) approaches in 79 adults with low back pain. Participants were randomly assigned to receive either TF-ESI (3 ml) or high-volume PIL-ESI (10 ml). All procedures were performed under fluoroscopic guidance. Contrast spread was evaluated by a blinded pain specialist, and clinical outcomes, including analgesia, patient satisfaction, and quality of life, were measured at two weeks, one month, two months, and six months post-treatment. Results showed no differences in baseline characteristics between groups. There were no statistically significant differences between the two groups in mean pain intensity at baseline and six months after treatment (p = 0.590 and 0.484, respectively). Pain relief, satisfaction, quality of life, and contrast spread to the anterior epidural space did not differ over six months. However, the TF group required significantly more fluoroscopic images (p < 0.001). High-volume PIL-ESI provides clinical efficacy and anterior contrast distribution equivalent to TF-ESI, with fewer fluoroscopic images needed.

Data availability

The original contributions presented in the study are included in the article; further inquiries can be directed to the corresponding author.

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Acknowledgements

The authors would like to appreciate the support and constructive comments of the research development office, Imam Khomeini Hospital Complex, Tehran, Iran.

Funding

The authors have not received any financial support for the research, authorship, and publication of this article.

Author information

Authors and Affiliations

  1. Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Narges Khojasteh

  2. Critical Care Medicine Department of Anesthesiology, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamedan, Iran

    Narges Khojasteh

  3. Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Hossein Majedi, Ali Emami Meibodi, Alireza Khajehnasiri, Reza Atef Yekta, Nader Ali Nazemian Yazdi, Mojgan Rahimi & Sogol Alikarami

  4. Department of Anesthesiology, Critical Care, and Pain, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Alireza Khajehnasiri & Reza Atef Yekta

  5. Department of Anesthesiology, Amir Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Nader Ali Nazemian Yazdi & Hamed Abdollahi

  6. Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran

    Koorosh Kamali

  7. Imam Khomeini Hospital Complex, Keshavarz Blvd, Tehran, 1419733141, Iran

    Hossein Majedi

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  1. Narges Khojasteh
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Contributions

Narges Khojasteh: project administration, enrolling participants, writing the original draft, and methodology. Hossein Majedi: conceptualization, project administration, writing the original draft and performing surgical interventions, evaluating the outcomes, and editing the manuscript. Ali Emami Meibodi, Ali Reza Khajenasiri, Reza Atef Yekta, and Nader Ali Nazemian Yazdi: evaluating the outcomes. Sogol Alikarami: preparation of the protocol, revision of the manuscript, and writing and editing. Mozhgan Rahimi, Koorosh Kamali, and Hamed Abdollahi: randomization, data analysis, writing, and editing. All authors read and approved the final manuscript.

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Correspondence to Hossein Majedi.

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Khojasteh, N., Majedi, H., Meibodi, A.E. et al. Comparison of epidural space contrast flow and clinical outcomes in parasagittal versus transforaminal epidural steroid injection. Sci Rep (2026). https://doi.org/10.1038/s41598-026-36056-6

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  • Received: 30 November 2024

  • Accepted: 09 January 2026

  • Published: 03 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-36056-6

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Keywords

  • Lumbosacral radicular pain
  • Parasagittal interlaminar epidural steroid injection
  • Transforaminal epidural steroid injection
  • Anterior epidural space
  • Neuropathic pain
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