Schaufele Michael K, Hatch Laura, Jones William
The Emory Spine Center, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
Pain Physician. 2006 Oct;9(4):361-6.
Epidural steroid injections are commonly used for the treatment of radicular symptoms associated with symptomatic lumbar intervertebral disc herniations. Transforaminal epidural injections are believed to produce better clinical outcomes than interlaminar epidural injections.
To determine a difference in short-term pain improvement and longterm surgical rates between interlaminar and transforaminal injection techniques.
Case Control Study.
For each technique, 20 patients were retrospectively identified who received their first fluoroscopically guided epidural steroid injection for radicular symptoms caused by a lumbar intravertebral disc herniation over an 18 months interval. All patients had corresponding MRI findings and failed previous non-invasive therapies. The Verbal Numerical Rating Scale (VNRS, 0-10 scale) before the treatment, within one hour after the treatment and upon follow-up (average 17.1 days) were analyzed, along with the need for repeat injections and surgical interventions over a 1-year follow-up interval. The patient groups were matched for symptom duration, MRI findings and pre-injection VNRS scores.
In the transforaminal group, there was a statistically significant improvement in the VNRS scores from before the injection (VNRS mean 5.9) to immediately after the injection (VNRS mean 2.9, p<0.01), and upon follow-up (VNRS mean 3.2, p<0.01, mean 18.7 days). Nine patients (45%) required 1 or 2 repeated injections, 2 patients (10%) underwent surgery. In the interlaminar group, there was a statistically significant improvement in the VNRS scores from before the injection (VNRS mean 7.3) to immediately after the injection (VNRS mean 3.1, p<0.01), and upon follow-up (VNRS mean 5.9, p<0.01, mean 15.6 days). Eight patients (40%) required 1 or 2 repeated injection, 5 patients (25%) underwent surgery. Fourteen patients (70%) had an improvement of 2 points or more on the VNRS scale in the transforaminal group, compared to 9 (45%) in the interlaminar group.
In the current study, transforaminal epidural steroid injections for the treatment of symptomatic lumbar disc herniation resulted in better short-term pain improvement and fewer long-term surgical interventions than interlaminar epidural steroid injection.
硬膜外类固醇注射常用于治疗与有症状的腰椎间盘突出症相关的神经根症状。经椎间孔硬膜外注射被认为比椎板间硬膜外注射能产生更好的临床效果。
确定椎板间和经椎间孔注射技术在短期疼痛改善和长期手术率方面的差异。
病例对照研究。
回顾性确定每种技术的20例患者，这些患者在18个月的时间间隔内首次接受了在荧光镜引导下的硬膜外类固醇注射，用于治疗腰椎间盘突出症引起的神经根症状。所有患者均有相应的MRI检查结果且先前的非侵入性治疗均失败。分析治疗前、治疗后1小时内及随访时（平均17.1天）的言语数字评定量表（VNRS，0 - 10分制），以及在1年随访期内重复注射和手术干预的需求。患者组在症状持续时间、MRI检查结果和注射前VNRS评分方面进行匹配。
在经椎间孔组，VNRS评分从注射前（VNRS平均5.9）到注射后即刻（VNRS平均2.9，p < 0.01）以及随访时（VNRS平均3.2，p < 0.01，平均18.7天）有统计学意义的改善。9例患者（45%）需要1次或2次重复注射，2例患者（10%）接受了手术。在椎板间组，VNRS评分从注射前（VNRS平均7.3）到注射后即刻（VNRS平均3.1，p < 0.01）以及随访时（VNRS平均5.9，p < 0.01，平均15.6天）有统计学意义的改善。8例患者（40%）需要1次或2次重复注射，5例患者（25%）接受了手术。经椎间孔组14例患者（70%）在VNRS量表上改善了2分或更多，而椎板间组为9例（45%）。
在本研究中，经椎间孔硬膜外类固醇注射治疗有症状的腰椎间盘突出症比椎板间硬膜外类固醇注射能带来更好的短期疼痛改善且长期手术干预更少。
