Abstract
ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.
Highlights
Low back pain (LBP) is one of the most frequent ailments for which patients seek medical attention
In patients who do not respond to the conservative treatment and who are contraindicated for surgical treatment, epidural steroid injections (ESIs) can be given
This study investigates the short- to medium-term aftereffects of ESIs in patients with herniated disc and lumbar canal stenosis (LCS)
Summary
Low back pain (LBP) is one of the most frequent ailments for which patients seek medical attention. Some people with symptoms suggestive of radiculopathy may not show any disc prolapse in an MRI or CT scan, while others without symptoms may present disc prolapse.[3] This contradiction has led to speculation on alternative explanations, since prolapsed intervertebral disc alone is not sufficient to produce features of radiculopathy One such speculation is that there may be some local chemical supplement causing damage to the nerve roots.[3] As technology has advanced, knowledge of radiculopathy has improved, leading to the realization that its pathogenesis is concomitant with inflammation, immunity, and mechanical compression.[4] Phospholipase A2 (PLA2), an essential element of the intervertebral disc, triggers the release of Arachidonic acid, which is a progenitor of Leukotrienes and Prostaglandins, leading to inflammation of the nerve roots.[5] Steroids are needed to reduce the inflammatory response incited by chemical, immunologic and mechanical mediators.[6,7,8,9] Steroids may be used in radiculopathy patients who do not respond to NSAIDs (non-steroidal anti-inflammatory drugs). This study investigates the short- to medium-term aftereffects of ESIs in patients with herniated disc and lumbar canal stenosis (LCS)
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