Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario

Abstract

ObjectivesTo present our experience with minimally invasive treatment of low back pain and sciatica with the computed tomography-guided percutaneous injection of steroids and local anaesthetics. Materials and methodsFrom August 2011 to June 2012, 102 patients underwent selective computed tomography-guided foraminal block for low back pain and sciatica treatment. Sixty-five patients received foraminal infiltration (64%), 29 epidural infiltration (28%), and 8 (8%) were subject to combined procedures. All procedures were performed on an outpatient basis with local anaesthetic, with no immediate complications. All patients received oral NSAIDs (non-steroidal anti-inflammatory drugs) prior to the procedure. A numeric scale of pain and the Oswestry index (IDO) was employed to measure local pain and limb disability. All patients showed at least 7 points in the initial evaluation. ResultsAll the patients showed a significant reduction in pain by the end of procedure. A clinical follow-up was made after 7 days, 1, 3, and 6 months after the treatment using the previously mentioned scales. Ninety-five patients (93%) showed a significant improvement in their symptoms, with suspension or decrease in oral medication. Six patients showed only a partial reduction of symptoms during the follow-up after one month, with a recurrence of symptoms after 3 months and restarted oral treatment. Four of these patients remained in the same IDO category with at least a 2 point decrease in the pain scale. Only one patient showed no improvement in symptoms during follow-up with a recurrence of symptoms 7 days after procedure, and for whom a second procedure was reprogrammed. ConclusionIn our experience CT-guided percutaneous lumbar selective nerve block using steroids and local anaesthetics, is an effective method of pain control with a very low incidence of complications.