Slipman Curtis W, Chow David W
Penn Spine Center, Rehabilitation Medicine, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Phys Med Rehabil Clin N Am. 2002 Aug;13(3):697-711. doi: 10.1016/s1047-9651(02)00004-9.
Current literature and a recent meta-analysis suggest a favorable role for corticosteroid injections in the nonoperative treatment of radiculopathy [70]. The superior results reported in recent literature may be attributable to precise fluoroscopically guided transforaminal placement of injectate close to the disc-nerve root interface and near the dorsal root ganglia, maximizing the therapeutic effect. The favorable results of corticosteroid injections in the treatment of radiculopathy caused by a focal disc herniation are consistent with the biochemical construct of radicular pain. The preliminary unfavorable results of therapeutic SNRB for radicular pain caused by epidural or intraneural fibrosis or occurring after trauma may relate to a biomechanical rather than a biochemical etiology. Outcomes for acquired cervical or lumbar spinal stenosis are intermediate compared with those observed for herniated discs and scarring or trauma. Such results may stem from the multifactorial origin of stenosis symptoms; they may develop from impaired venous flow, restricted neural glide, inflammation, or structural root injury. Better-designed studies that use strict inclusion criteria that stratify patients into categories according to the mechanism of injury (atraumatic versus traumatic), the presence or absence of neurologic deficits or imaging abnormalities, and prior treatment will provide the basis for evidence-based treatment decisions. Such an emphasis is just beginning and inevitably will occur. Until then, decisions have to be predicated on the limited and flawed work conducted to date [71]. Nevertheless, the information gleaned from these published reports provides valuable insight not available just a decade ago.
当前的文献以及最近的一项荟萃分析表明，皮质类固醇注射在神经根病的非手术治疗中具有积极作用[70]。近期文献报道的较好结果可能归因于在透视引导下将注射剂精确地经椎间孔放置在靠近椎间盘-神经根界面和背根神经节附近，从而使治疗效果最大化。皮质类固醇注射治疗因局灶性椎间盘突出引起的神经根病的良好效果与神经根性疼痛的生化机制相符。治疗性选择性神经根阻滞（SNRB）对硬膜外或神经内纤维化或创伤后引起的神经根性疼痛初步产生的不利结果可能与生物力学而非生化病因有关。与椎间盘突出、瘢痕形成或创伤相比，获得性颈椎或腰椎管狭窄的治疗结果处于中等水平。此类结果可能源于狭窄症状的多因素起源；它们可能由静脉血流受损、神经滑动受限、炎症或结构性神经根损伤发展而来。设计更完善的研究，采用严格的纳入标准，根据损伤机制（非创伤性与创伤性）、有无神经功能缺损或影像学异常以及既往治疗情况将患者分类，将为基于证据的治疗决策提供依据。这种重视才刚刚开始，而且不可避免会出现。在此之前，决策必须基于迄今为止所做的有限且有缺陷的研究[71]。然而，从这些已发表报告中收集到的信息提供了仅在十年前还无法获得的宝贵见解。
