Ackerman William E, Ahmad Mahmood
Pain Medicine Consultants P.A., Little Rock, Arkansas 72223, USA.
Anesth Analg. 2007 May;104(5):1217-22, tables of contents. doi: 10.1213/01.ane.0000260307.16555.7f.
Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations.
Ninety patients aged 18-60 years with L5-S1 disk herniations and radicular pain were randomly assigned to one of these groups to have epidural steroid injection therapy every 2 wk for a maximum of three injections. Pain relief, disability, and activity levels were assessed.
Pain relief was significantly more effective with TF injections. At 24 wk from the initiation of this study, pain relief was as follows: C: complete pain relief: 1/30, partial pain relief: 16/30, and no relief: 13/30; IL: complete pain relief: 3/30, partial pain relief: 15/30, and no relief: 12/30; and TF: complete pain relief: 9/30, partial pain relief: 16/30, and no relief: 5/30.
The TF route of epidural steroid placement is more effective than the C or IL routes. We attribute this observation to a higher incidence of steroid placement in the ventral epidural space when the TF method is used.
腰椎硬膜外类固醇注射可通过三种方法之一完成：骶管注射（C）、椎板间注射（IL）或经椎间孔注射（TF）。在本研究中，我们试图确定这些技术对治疗与腰椎间盘突出症相关的神经根性疼痛的疗效。
90例年龄在18至60岁之间、患有L5 - S1椎间盘突出症和神经根性疼痛的患者被随机分配到这些组中的一组，每2周进行一次硬膜外类固醇注射治疗，最多注射三次。评估疼痛缓解情况、功能障碍和活动水平。
经椎间孔注射在缓解疼痛方面明显更有效。在本研究开始后的24周时，疼痛缓解情况如下：骶管注射组：完全缓解疼痛1/30，部分缓解疼痛16/30，无缓解13/30；椎板间注射组：完全缓解疼痛3/30，部分缓解疼痛15/30，无缓解12/30；经椎间孔注射组：完全缓解疼痛9/30，部分缓解疼痛16/30，无缓解5/30。
硬膜外类固醇注射的经椎间孔途径比骶管注射或椎板间注射途径更有效。我们将这一观察结果归因于使用经椎间孔方法时，类固醇置于腹侧硬膜外间隙的发生率更高。
