Epidural Infiltration Research Articles

Unveiling relevant emotions, cognitions, and behaviours from the viewpoint of people with chronic low back pain: A qualitative study with patient involvement

ObjectiveTo gain insight into the emotions, cognitions, and behaviours experienced by people with chronic low back pain (CLBP) undergoing invasive treatment in a pain unit. DesignA cross-sectional qualitative study based on individual interviews. This study included patient involvement in its design and development. MethodsAn interpretative phenomenological approach was adopted to understand the multidimensional experience of patients. The interview script was a translated, adapted, and expanded version of the one proposed by Cognitive and Functional Therapy. A mixed coding method was applied to structure the interviews. Three themes were created, with the three most frequently reported emotions, cognitions, and behaviours as subthemes. A patient with CLBP approved the initial protocol and the aim of the study. Subsequently, the patient contributed questions to the interview script, checked the coding process, and approved the final version of the manuscript. ResultsTwenty-two patients undergoing epidural infiltrations in a pain unit were interviewed. (i)“Fears”, (ii)“Frustration”, and (iii)“Worry” were the three most commonly expressed emotions. Cognitions related to (i)“Pain predictability”, (ii)“Pain description and perception”, and (iii)“Pain interference/disability” were also widely reported. The theme “Behaviours” was composed of the following subthemes: (i)“Strategies for managing symptoms”, (ii)“Social behaviours”, and (iii)“Strategies for coping with daily tasks”. Noteworthily, cognitions related to the (i)“Diagnosis”, (ii)“Health system attention”, and (iii)“Medical prescriptions” arose from questions provided by patient involvement. ConclusionPatients with CLBP expressed a wide variety of emotions, cognitions, and behaviours that must be considered by health professionals with the goal of providing the best patient-centred care.

Rare yet Critical Manifestations: A Case of Langerhans Cell Histiocytosis in a Child Presenting with Belt-Like Dorsalgia: Diagnostic and Therapeutic Approach

Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans cells. We present the case of a 9-year-old girl complaining of recent belt-like dorsalgia, whose imaging revealed dorso-lumbar scoliosis and a tumor mass at the posterior arch of T11 with posterior epidural infiltration. Surgical decompression and tumor resection were performed, histopathologically confirming the diagnosis of LCH. This abstract highlight the diagnostic and therapeutic challenges of LCH, emphasizing the importance of a multidisciplinary approach for effective management of this rare disease. Additionally, it underscores the relevance of early intervention and meticulous follow-up to ensure optimal outcomes for patients with LCH.

The anatomy of pain relief: Lumbar oxygen-ozone epidural infiltrations for cervicobrachialgia

Objective: This study investigates the efficacy and safety of epidural infiltration with drugs and an oxygen-ozone mixture for treating cervicobrachialgia due to disc-radicular conflict or on a degenerative basis, utilizing both retrospective analysis and direct visualization techniques. Methods: A retrospective study involving 10 patients treated with epidural infiltrations of an oxygen-ozone mixture and cortisone was conducted. The procedures were performed under CT guidance to ensure precise delivery and to monitor the diffusion of the injected substances. Pain levels were assessed using the Numerical Rating Scale (NRS) and treatment efficacy was evaluated based on symptom relief and reduction in NSAID intake. Results: Significant pain reduction was observed post-treatment, with median NRS scores decreasing from 9 (baseline) to 2 (follow-up), and a significant decrease in on-demand NSAID intake. Only one minor complication of a headache was reported. The study also demonstrated the ability of ozone to diffuse through the epidural adipose tissue, potentially enhancing treatment efficacy. Conclusion: The combined use of an oxygen-ozone mixture and cortisone for epidural infiltration is an effective and safe treatment for cervicobrachialgia, offering significant pain relief and minimizing the risk associated with traditional epidural injections. This technique presents a viable non-surgical option for patients suffering from disc-radicular conflict or degenerative conditions.

Revolutionizing Back Pain Management: Is Epidural Platelet-Rich Plasma the Superior Choice Over Steroids?

Background and objective Low back discomfort is one of the main factors that restrict physical activity, and it is becoming more and more common. Surgery is the best option when all other conservative treatment methods have failed, but it is not a panacea. While local anesthetic-free and combined epidural steroid injections have been used for many years, their usefulness is limited to shorter periods. In the field of orthopedics, platelet-rich plasma (PRP) has gained widespread recognition as an adjuvant component. PRPhas been applied to improve tissue repair, both soft and hard.This comparative study aimed to evaluate the potential of PRP as atherapy for low back pain (LBP). Methods We included 64 adult individuals with complaints ofLBP. They were classified into two groups: group A underwent a single injection in the afflicted lumbar intervertebral disc (IVD) level with 1.5 ml of methylprednisolone, 1.5 ml 2% lidocaine, and 0.5 ml of saline under rigorous aseptic precautions; in contrast, group B was administered a single injection of 3 milliliters of autologous PRP. Patients' scores on the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Straight Leg Raising Test (SLRT) were assessed before and during therapy. Results The datagathered were subjected to statistical analysis. Statistically significant differences were found in the VAS scores between group A (methylprednisolone group) and group B (PRP group) post-one hour (6.0 ±0.74 vs. 6.92 ±0.57) and after three months (5.2 ±0.65 vs. 3.26 ±0.79). Conclusions Our study revealed gradual progressive improvement in the symptoms of patients in the PRP group as indicated by scores onSLRT, VAS, and MODQ. The results were comparable to those who received methylprednisolone injections. There was a statistically significant difference in VAS scores between the two groups, with the PRP group reporting a higher degree of pain reduction, showing that PRP is an effective alternative to epidural steroid infiltration in managing chronic LBP.

Pediatrics severe low back pain by disc herniation: an uncommon entity

BackgroundCommon severe back pain due to disc herniation is rare in the paediatric population which involves children under eighteen years of age. Paediatric lumbar disc herniation (LDH) cannot be considered the same disease as in adults, as it has potentially different natural and clinical backgrounds. The treatment of pediatric LDH is the other particularity of this condition. Indeed, in children, delaying surgery for a conservative treatment is justified. We report 3 cases treated in 8 years.Case presentationThree patients, two of whom were 14 years of age and one 17 years of age, were admitted for L5 or S1 lumbosciatica. A CT scan showed a lumbar disc herniation L5S1 associated with bi-isthmic lysis (and a transitional abnormality in 1 case or spina bifida occulta in 1 other case). The last patient had an magnetic resonance imaging (MRI) that showed a herniated L4L5 disc. The diagnosis of low back pain disc herniation was retained in two patients and that of disabling low back disc in one patient. Percutaneous discolysis in the two hyperalgesic cases and epidural corticosteroid infiltration in the disabling case were effective on lumbosciatica.ConclusionPaediatric common lomw back pain caused by a disc herniation with a hyperalgic or disabling character posed a therapeutic problem which were solved by the invasive approaches that must be given priority nowadays with children.

The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis

Background: Lower back pain is a common cause of disability that affects mobility and quality of life (QOL) in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, analgesics, physiotherapy, and epidural steroid infiltration. Despite multiple attempts of conservative management, if a patient develops refractory radicular pain with or without neurologic deficit and claudication, surgery is indicated. The two main approaches to surgical intervention include decompression (laminectomy only) and decompression with fusion [transforaminal lumbar interbody fusion (TLIF)].
 Methods: The study was done between May 2019 and November 2022. In this randomized study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis. Forty patients with single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis were randomly divided into two equal groups. Patients in both groups were followed up for 2 years.
 Results: In this study, we also noted estimated amount of blood loss, procedure time, time taken for ambulation, length of hospitalization, and demography. The Oswestry Disability Index (ODI) scores improved significantly postoperatively. The modified MacNab criteria suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.
 Conclusion: We evaluated that TLIF procedures were associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied; TLIF provides early ambulation but a higher cost of treatment and longer hospital stay compared to laminectomy. Laminectomy procedures are associated with lesser economic burden, hospital stay, and blood loss, as well as shorter surgical duration compared to TLIF.

Plasma Rich in Growth Factors (PRGF) in the Treatment of Patients With Chronic Cervical and Lumbar Pain: A Prospective Observational Clinical Study

BACKGROUND: Chronic back pain is a long-lasting disorder, whose main source of pain is often the intervertebral disc that undergoes a degenerative process associated with low-grade inflammation, leading to a reduced quality of life. OBJECTIVES: The aim of our study was to assess the efficacy of intradiscal and epidural injections of plasma rich in growth factors (PRGF) in patients with chronic clinical symptoms due to intervertebral disc (IVD) degeneration. STUDY DESIGN: Prospective observational study. SETTING: A single spine unit in a private clinic. METHODS: Thirty-two patients with cervical and lumbar chronic pain due to IVD degeneration were treated with 2 or 3 series of intradiscal and epidural PRGF infiltrations with 2 weeks between each procedure. The procedures were performed under fluoroscopic guidance and grade 3 sedation in an operating theater. Treatment efficacy was evaluated using the Spine Tango Core Outcome Measure Index questionnaire, Numeric Rating Scale for back pain, and the Oswestry Disability Index questionnaire. In addition, the number of patients who successfully achieved the minimal clinically important change was also determined. These assessments were evaluated at pretreatment (baseline) and at one, 3, and 6 months posttreatment. RESULTS: The Oswestry Disability Index, COMI Spine Tango Core Outcome Measure Index total score, and Numeric Rating Scale showed a statistically significant reduction from the baseline level to the posttreatment first month, third month, and sixth month (P < 0.001). Moreover, 78.1% of the patients reached a pain reduction superior to 30% one month posttreatment, and 87.5% at 6 months posttreatment, which is considered as a clinically significant improvement. LIMITATIONS: This study was prospective and did not have a control group. Only patient-reported outcomes were evaluated. CONCLUSIONS: This observational, prospective study of patients with chronic back pain showed that 2-3 intradiscal and epidural injections of PRGF significantly decreased pain and disability at one month posttreatment and this improvement was maintained, and in some patients even improved, at 3, and 6 months posttreatment. KEY WORDS: Platelet-rich plasma, plasma rich in growth factors, degenerative disc disease, intervertebral disc degeneration, back pain, growth factors, regenerative medicine

Efficacy of epidural infiltration in the management of pain and disability due to acute and subacute lumbosacral radiculopathy

Background and ObjectiveEpidural infiltrations are used for treatment of low back pain and sciatica. Linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. MethodsIs a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). ResultsNinety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47 ± 11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48 ± 1.5 basal; 6.2 ± 0,9 at 15 days; 6.3 ± 1.2 at one month; 6.15 ± 1.3 at 3 months, p < 0.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. ConclusionsEpidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.

Randomised control trial of epidural platelet rich plasma versus epidural steroids for low back pain

Background: Lower back pain (LBP) is a prevalent medical condition that frequently results in work-related disability and is one of the leading causes of missed workdays. Low back pain (LBP) struck 619 million people worldwide in 2020, and by 2050, it's predicted that there will be 843 million instances worldwide. 70 to 85% of people are predicted to suffer from LBP at some point of time in their lives. 90% of these people will experience multiple episodes, and an intervertebral disc prolapse accounts for a significant portion. Medications and lifestyle adjustments may be used as the first line of treatment. However, if the symptoms do not improve, minimally invasive procedures such as epidural steroid injection and epidural platelet-rich plasma injection may relieve the pain and lessen disability. We therefore aim to conduct a study to analyse the patient’s functional status and satisfaction after epidural platelet-rich plasma infiltration. Methods: Eligible patients with low back pain will be divided into two groups(Group A and Group B). Patients in group A will receive epidural steroid whereas Group B will receive epidural Platelet rich plasma. These patients will be monitored where visual analogue scale will be used to assess relief of pain before and after the procedure, Straight leg raising test will be used to understand the improvement of the patient clinically during examination pre and post procedure. Oswestry disability index will be used to compare the outcome in patient's day to day activities before and after the intervention. Patients will be evaluated with these methods pre-procedure and 1 hour after and later follow up evaluation will be done after 3 weeks and 3 months. The follow-up scores will be taken post one hour, three weeks and three months of the treatment. Protocol version: v1 dated 04/07/23 CTRI registration: REF/2023/06/068736 (12/06/2023)

Eficacia de las infiltraciones epidurales en el abordaje del dolor y la discapacidad por radiculopatía lumbosacra aguda y subaguda

Backgrund and objectiveEpidural infiltrations are used for treatment of low back pain and sciatica. linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work. MethodsIs a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal). ResultsNinety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47±11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48±1.5 basal; 6.2±0,9 at 15 days; 6.3±1.2 at one month; 6.15±1.3 at 3 months, P<.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections. ConclusionsEpidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.

Pre-operative single shot epidural with bupivacaine and dexmedetomidine in lumbar spine surgeries – A case report

Introduction : spine surgeries and associated pain is a major setback in most of cases and is a stupendous task to manage. Reducing the requirement of para-enteral analgesics improves the outcome and minimizes the associated side effects. Case Report : patient posted for lumbar decompression with chronic renal disease was managed by single shot epidural infiltration of 0.25% bupivacaine with 20 mcg of dexmedetomidine for intra-op as well as post operative analgesia, which reduced the requirement of NSAIDS or Opioids and inturn reduced the associated side effects and provided better hemodynamic stability. Conclusion : Managing patient with chronic renal disease is difficult task as NSAIDS can cause futher damage to the kidneys. One of the ways to reduce immediate post operative and intra-operative pain is via single shot epidural analgesia which we have discussed in our case report.

Sciatica. Management for family physicians.

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

Role of Epidural Steroid and Local Anesthetic in Post-Operative Outcome Following Lumber Discectomy

Aim: The purpose of the study was to assess the outcome of epidural infiltration of local anesthetic and steroid intraoperatively in comparison with placebo (saline) after lumbar discectomy. Study Design: A prospective double blinded randomized controlled trial conducted in a tertiary care centre over two and half years’ duration, from July 2019 to December 2021 Methods: 70 subjects enduring lumbar discectomy were randomised to the intraoperative infiltration of triamcinolone acetonide (40mg/ml, 2ml) and bupivacaine (0.5%, 3ml) in A group or B group who were given equal (5ml) volume of normal saline. Infiltration was achieved after decompression and discectomy, and just before the incision was closed. In the postoperative period, the standard procedure of physiotherapy and intravenous paracetamol administration were used. Supplementary analgesics with tramadol was used solitary in patients requiring greater pain control. The VAS scale was used to access pain post-operatively and use of opioids was documented. Primary outcomes measures included immediate post-operative VAS back pain, infection rate and opioid use. The subjects were reassessed at six-weeks and three months after surgery. Results: No patient in A group needed opioid analgesic while 14 patients in group B needed additional tramadol as a pain killer for pain relief (p = 0.01). At the third hour after surgery, the VAS result was lower significantly in A group in comparison to the group B (p &lt;0.05). No infection or other serious complication was reported and no revision surgery was performed in either group. One patient in each group stated residual radiculopathy, but after 6 weeks both patients’ symptoms resolved. Conclusions: Intraoperative administration of local anaesthetics and steroids is fruitful in reducing pain only for a brief time afterwards the surgical procedure, without affecting the infection rate and long-standing outcomes in comparison to the placebo. Keywords: Triamcinolone, Bupivacaine, Lumber discectomy, Postoperative pain

Is Ultrasound-Guided Transversus Abdominis Plane Block Superior to a Caudal Epidural or Wound Infiltration for Intraoperative and Postoperative Analgesia in Children Undergoing Unilateral Infraumbilical Surgery? A Double-blind Randomized Trial.

ABSTRACTBackground and Aim:Caudal block (CB) is the standard of care in pediatric surgeries. Ultrasound (USG) transversus abdominis plane (TAP) block has also been used as an effective regional anesthesia technique. We compared the duration of postoperative and intraoperative analgesia between TAP block, CB, and local wound infiltration (LI) in children undergoing unilateral infraumbilical abdominal surgery.Materials and Methods:One hundred and twenty children, 3–10 years old and American Society of Anesthesiologists Grade I and II, undergoing elective unilateral infraumbilical abdominal surgery were allocated to three groups. Group TAP: USG-guided TAP block with 0.5 ml/kg of 0.25% bupivacaine; Group CB: CB with 0.75 ml/kg of 0.25% bupivacaine; and Group LI: Local wound infiltration along the incision with 0.5 ml/kg of 0.25% bupivacaine. The primary outcome was the efficacy of postoperative analgesia using modified objective pain score (MOPS), and the secondary outcome was to determine intraoperative analgesia with fentanyl requirement and minimum alveolar concentration (MAC) hour of isoflurane among the three groups.Results:The MOPS was statistically better in Group TAP compared to group CB and group LI at 8 and 24 h postoperatively. The mean ± standard deviation duration of postoperative analgesia in groups CB, LI, and TAP was 6.84 ± 0.47, 2.3 ± 1.26, and 9.78 ± 1.02 h, respectively. The intraoperative requirement of fentanyl and MAC hour was least in Group CB.Conclusion:We found that USG-guided TAP block is a good alternative, with longer and effective postoperative analgesia compared to CB. However, the quality of intraoperative analgesia was best in group CB. Local infiltration was a poor alternative.

Clinical profile of patients with lumbar disc prolapse

The motion in the lumbar spine is divided between five motion segments, although a disproportionate amount of the motion is in the lower segments (L3-L4 and L4-L5). The two lowest discs (L4-L5 and L5-S1) take the most strain and are the most likely to herniate. This can cause lower back pain and possibly numbness that radiates through the leg and down to the foot (sciatica). Written informed consent for participation in the study was obtained from all the subjects. After the patient’s informed consent was obtained, 150 patients with lumbar disc prolapse were subjected to epidural steroid infiltration out of which 101 underwent IL procedure and 49 underwent TF epidural steroid injections under the fluoroscopic guidance according to surgeons preference. As per my study out of the total 150 patients, 105(70%) improved in their symptoms only with epidural steroid and 45 patients (30%) proceeded to surgery, which was statistically significant.

Lumbar discectomy in post epidural steroid treated patients for disc prolapse

Aim: In spine surgery, it is common practice to thoroughly exhaust all conservative measures before surgery. With the increasing popularity of injection procedures, significant number may still require surgery post epidural steroid infiltration (ESI). We aim to study the incidence of such patients who eventually go in for surgery after a failed ESI. We also studied and compared the functional outcomes of transforaminal (TF) versus interlaminar (IL) procedures in intervertebral disc prolapse (IVDP) patients. Materials and Methods: 150 patients with lumbar disc prolapsed were subjected to epidural steroid infiltration after 6 weeks of failed conservative management, of which 101 underwent IL and 49 TF procedure according to surgeon's preference, and followed up for 6 weeks. Those with persisting (or worsening) Visual analogue scale (VAS), Modified Oswestry diability index (ODI) and with progressive neurological deficits, underwent lumbar discectomy and all were followed up for 6 months.Results: Out of 150 patients, 45 patients underwent discectomy (30 %) after total 6 months follow up, and out of the remaining 105 patients, 40 (81.6%) from TF group and 65 (64.4%) from IL group improved. In total, 62% of females went to surgery, Minimal disability in ODI score was seen in 77.8% in surgery group and 98.1% in epidural group at final follow up.Conclusion: Our study observed a much smaller crossover rate (30%) to surgery, and a significant difference in outcomes of the two injection methods and concludes that TF is a better procedure than IL.

Plasma Rich in Growth Factors (PRGF) in the Treatment of Cervical and Lumbar Back Pain: A Retrospective Observational Clinical Study

Plasma rich in growth factors (PRGF) is a leukocyte-free platelet-rich plasma (PRP) that is an effective biological approach to tissue repair and has been demonstrated to significantly improve multiple conditions, including low back pain and degenerative disc pathology. The objective of this retrospective study was to analyze the effectiveness of treating both cervical and lumbar spine pain with minimally invasive infiltrations of PRGF-Endoret. Retrospective study design. Outpatient private practice facility. The effectiveness of PRGF has been assessed by patient-reported outcomes (PRO) through validated questionnaires, namely Numeric Rating Scale (NRS) for back pain, Spine Tango Core Outcome Measure Index (COMI) Questionnaire for lumbar and cervical pain, and OSWESTRY Disability Index questionnaire for lumbar pain cases. Score differences between pre- and post-treatment have also been assessed stratified for multiple sub-groups of patients based on the sector of the column treated, gender, and age. This study includes 65 patients (18 with cervical pain and 47 with lumbar back pain). The average time of back pain evolution was 10 years. Patients received at least 2 PRGF infiltration series about one month apart. Each patient received intervertebral disc and epidural infiltrations, root infiltrations, in case of radicular injury, and intraarticular infiltrations, in case of osteoarthritis of the facet joints. Results show statistically significant (P < 0.05) improvements on all analyzed scores. Regarding the stratified analyses, 249 (99%) sub-groups showed an improvement in all tests (252 cases overall). From the 249 improving cases, 154 (62%) showed a statistically significant difference between the pre- and the post- treatment periods. This research is a retrospective study with a relatively small sample cohort. Only PRO have been assessed. According to the results obtained in this study, and taking into account their limitations, PRGF infiltrations are an effective and minimally invasive biological strategy in the treatment of both cervical and lumbar pain, evaluated according to PRO.

Effectiveness of CT-guided epidural infiltration of steroids and local anesthetics for acute and chronic herpes zoster neuralgia

PurposeThe purpose of this study was to evaluate the effectiveness and complication rate of computed tomography (CT)-guided epidural injection of steroids and local anesthetics for pain relief in patients with neuralgia due to acute or chronic herpes zoster (HZ). Materials and methodsA prospective study was conducted from April 2017 to February 2019 including patients with HZ neuralgia (HZN) at any stage (acute or chronic, the latter being defined as pain lasting more than 3 months and also called post herpetic neuralgia [PHN]). The sensory ganglion of the affected dermatome and/or the affected sensory nerve was targeted under CT-guidance and local injection of a mixture of two vials of methylprednisolone 40mg/mL and 2mL of Lidocaine 1% was performed. Using a visual analogue scale (VAS, 0 to 10), pain was assessed prior to the procedure, and at day 7, 1 month, 3 months and 6 months. Adverse effects were graded according to the Society of Interventional Radiology classification. ResultsTwenty patients were included. There were 9 men and 11 women with a mean age of 67±13.9 (SD) years (range: 27–83 years). Of these, 14 patients had acute HZN and 6 had PHN. Mean VAS at baseline was 8.1±1.2 (SD) (range: 6–10) with significant decrease (P<0.0001) at day 7 (3.4±3.2 [SD]; range: 0–10), day 30 (3.4±3.2 [SD]; range: 0–9), day 90 (2.9±3.2 [SD]; range: 0–9), and day 180 (2.5±3.1 [SD]; range: 0–9). Infiltrations were significantly more effective on acute HZN than on PHN (P<0.001) and required significantly fewer infiltrations for pain relef (P=0.002). Only one grade A adverse event was reported. ConclusionEpidural injection of a mixture of steroids and local anesthetics under CT-guidance is effective on HZN with a persisting effect over 6 months.

Subdural image after administration of contrast prior to epidural infiltration in a patient with chronic pain

Subdural image after administration of contrast prior to epidural infiltration in a patient with chronic pain

What is the Impact of Lumbosciatic Infiltration on the Evolution of Herniated Disc and Dorsolumbar Asthrosis?

Lumbosciatica is a frequent reason for consultation in general medicine and emergency medicine with an estimated incidence between 2% and 14%. There are several therapeutic modalities, including infiltrations, which are very controversial. Based on this observation, we conducted a prospective study in which 19 patients had undergone epidural and peri-radicular infiltration; the epidural was the most represented infiltration in 68.4% of the patients, the peri-radicular was in 21.1% of them and the combination of both was in 10.5% of the cases, with only 30.6% of the infiltrations carried out under radioscopy. The molecules used were Triamcinolone Acetonide-based Kenacort and Methylprednisolone Acetate-based Depo-Medrol. The evolution of post-infiltration pain decreased significantly in 94.7% of cases, with a statistically significant difference (p = 0.04). No complications were observed in our patients and none of them had resorted to surgery during the follow-up period except for a single case of recurrence of pain relieved by periodic spaced infiltrations. Despite the small size of our sample, we can conclude that infiltration techniques still have a place in the management of Lumbosciatica alongside the surgery.