Buttermann Glenn R
Midwest Spine Institute, Stillwater, Minnesota 55082, USA.
J Spinal Disord Tech. 2002 Dec;15(6):469-76. doi: 10.1097/00024720-200212000-00007.
In some lumbar disc herniation patients, noninvasive measures fail, necessitating more aggressive treatment, such as epidural steroid injections or surgery. This study sought to determine whether improvement in patients who receive epidural steroid injections is related to regression of herniated nucleus pulposus or whether such patients' symptoms decrease because of the steroid effect in the presence of continued herniated nucleus pulposus. Two nonoperatively treated patient cohorts were followed who had follow-up MRI. Specifically, 38 other patients who improved without invasive treatment within 6 weeks after the onset of their symptoms were compared with 20 patients who improved with epidural steroid injections. Results found that both groups had similar initial and follow-up herniated nucleus pulposus size and outcomes. The epidural steroid injection group had fewer sequestered or extruded herniations that resorbed, and most were of lower hydration. In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression. Patients in whom the disc herniation has less hydration may have prolonged symptoms, but many improve with epidural steroid injections.
在一些腰椎间盘突出症患者中，非侵入性治疗措施无效，需要更积极的治疗，如硬膜外类固醇注射或手术。本研究旨在确定接受硬膜外类固醇注射的患者病情改善是否与突出的髓核回缩有关，或者这些患者的症状减轻是否是因为在髓核持续突出的情况下类固醇的作用。对两个非手术治疗的患者队列进行了随访，并对其进行了MRI复查。具体而言，将38例在症状出现后6周内未经侵入性治疗而病情改善的患者与20例经硬膜外类固醇注射后病情改善的患者进行了比较。结果发现，两组患者最初和随访时的髓核突出大小及治疗结果相似。硬膜外类固醇注射组中吸收的游离或脱出型突出较少，且大多数突出的髓核水化程度较低。总之，硬膜外类固醇注射不会改变最终的髓核突出回缩情况。髓核水化程度较低的椎间盘突出症患者可能症状持续时间较长，但许多患者经硬膜外类固醇注射后病情会改善。
