Early Radiographic Improvement of Pain-Induced Sciatic Scoliosis Following Transforaminal Epidural Steroid Injection in Lumbar Disc Herniation: A Prospective Cohort Study.

BACKGROUND: Sciatic scoliosis is commonly observed in patients with lumbar disc herniation and is believed to represent a compensatory response to radicular pain. While surgical decompression has been shown to correct this deformity, the potential for nonoperative interventions to induce similar radiographic improvement remains unclear. Therefore, the present study aims to evaluate early radiographic and clinical changes in sciatic scoliosis following transforaminal epidural steroid injection (TFESI) in patients with lumbar disc herniation. METHODS: A prospective cohort study was conducted, including 25 patients with lumbar disc herniation and associated sciatic scoliosis. Radiographic parameters, including lumbosacral Cobb angle, compensatory thoracic/thoracolumbar curve, and trunk shift, were assessed at baseline and at 3 weeks, and 6 weeks after intervention. Clinical outcomes included visual analog scale and Oswestry Disability Index. RESULTS: Significant reductions in lumbosacral Cobb angle were observed at 3 and 6 weeks (12.56°-6.68° and 4.48°, respectively; P < 0.001). Compensatory thoracic/thoracolumbar curves and trunk shift also improved significantly. At 6 weeks, 84% of patients achieved normalization of the lumbosacral curve (<10°), and 88% demonstrated ≥50% improvement. Significant improvements in pain and functional outcomes were also observed. CONCLUSIONS: TFESI is associated with early improvement of pain-induced sciatic scoliosis and coronal imbalance. These findings suggest that radicular pain plays a key role in the development of this deformity and that its resolution may result in reversible postural correction. TFESI may also serve as a useful clinical tool in distinguishing flexible, pain-related deformity from structural scoliosis prior to surgical decision-making. CLINICAL RELEVANCE: These findings support the use of TFESI as an effective nonoperative strategy for early correction of sciatic scoliosis and symptom improvement, potentially reducing the need for surgical intervention.