ArticleJournal of orthopaedic case reports2026
Evaluation of Changes in Spinal Posture Following Fluoroscopy-Guided Transforaminal Epidural Steroid Injection in Chronic Low Back Pain using the DIERS Formetric 4D Spine Posture Analysis System: A Prospective Observational Study.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Chronic low back pain (CLBP) is a common cause of pain, disability, and impaired quality of life. Persistent pain often leads to compensatory postural changes, including pelvic asymmetry, coronal imbalance, and vertebral rotation. Although fluoroscopy-guided transforaminal epidural steroid injection (TFESI) is an established treatment for patients who fail conservative therapy, its effects on spinal posture have not been well studied. This study aimed to evaluate changes in spinal posture following TFESI using the radiation-free DIERS formetric 4D spine posture analysis system, along with changes in pain, disability, quality of life, and neural mobility. Materials and Methods: This prospective observational study included 43 patients aged 18-60 years with magnetic resonance imaging-confirmed CLBP refractory to at least 6 weeks of conservative management. All patients who were planned for fluoroscopy-guided TFESI were included. Clinical outcomes assessed at baseline and 8 weeks included the visual analog scale, modified Oswestry disability index, short form-12, and straight leg raise test (SLRT). Spinal posture was evaluated using the DIERS formetric 4D system, measuring sagittal alignment, spinal curvature, pelvic parameters, coronal imbalance, and vertebral rotation. Statistical analysis was performed using the Wilcoxon signed-rank test and McNemar test. Results: Significant improvements were observed in pain, disability, quality of life, and SLRT angle (all P < 0.0001). Objective posture analysis demonstrated significant improvements in pelvic obliquity (P = 0.011), coronal imbalance (P < 0.0001), and vertebral rotation (P ≤ 0.001). However, no significant changes were noted in sagittal imbalance, thoracic kyphosis, lumbar lordosis, cervical or lumbar sagittal arrows, or pelvic torsion. Conclusion: Fluoroscopy-guided TFESI provides significant short-term improvements in pain, function, quality of life, and selected spinal posture parameters in patients with CLBP. The DIERS formetric 4D system is a reliable, radiation-free tool for objectively monitoring postural changes following interventional treatment.
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