The efficacy of lumbar epidural steroid injections in “failed back surgery syndrome” and lumbar radiculopathy

Abstract

Aims: Lumbago is one of the common conditions in our present community. Definite periods of human’s life people encountered in the form of usually regressing attacks that %10-%15 of this important condition requires surgical therapy. Cause of wrong diagnosis and treatment Spinal surgery may not always give favourable result. Patients undergone one or more back surgery exist back and/or leg pain which does not improve, is called failed back surgery syndrome. Epidural steroid administration is one of the most invasive method which is used in back pain. Effects and application results are controversial. In this study we aimed to compare the effects of steroid and local anesthetic solutions which administered by epidural way on pain controlling between the patients that have chronic back pain because of lomber radiculopathy, undergone surgery and not surgery. Methods: It was evaluated retrospectively pain controlling effect of administered steroid and local anesthetics by interlaminal epidural way to ASA 1-2-3, between 18-80 aged 40 patient which undergone piror one or plural back surgery and have no surgery between May 2009-December 2009 apply with back pain complaint to İstanbul Education and Research Hospital Algology Department. Patient’s visuel analog scala (VAS) and severity of back pains, before procedure, second week after procedure, fourth week after procedure, sixth week after procedure in either two groups out of ten points was estimated. Results: Totally of 7 ml solution which contains 1 ml triamsinolon asetonid 40 mg/ml (Sinakort-A ampul, İ.E. Ulugay), 3 ml levobupivacaine 5mg/ml ( Chirocaine ampul, Abbott) and 3 ml serum phsiyologic ( % 0,9 NaCl ) administered by epidural way into either two group patients. There were no significant difference between two groups by mean of age, weight, height, BMI and back pain durations. Evaluating the groups into themselves, opioid requirements and VAS scores before injection was markedly higher than 2,4 and 6. week scores in either two groups (p<0.05). There was no statistically significant difference when we compare into groups of 2,4 and 6. week opioid requirements and VAS scores in either two groups. All patient manifested their pleasure and there was no complication occured. Conclusion: Consequently; it was thought that epidural administration of steroid (triamsinolon) ,local anesthetics (levobupivacaine) and serum physiologic solution was effective especially on early back pain treatment, also safe method and beneficial to patient satisfaction in the patients who has failed back surgery and chronic back pain.