Botwin Kenneth, Brown Lee Ann, Fishman Mark, Rao Sanjiv
Florida Spine Institute, Clearwater, FL 33765, USA. contactus@ floridaspineinstitute.com
Pain Physician. 2007 Jul;10(4):547-58.
Caudal epidural steroid injections are commonly utilized to help reduce radicular pain in lumbar spinal stenosis. There have been studies done to evaluate the effectiveness of this procedure non-fluoroscopically guided. Search revealed no prospective studies evaluating the effectiveness of fluoroscopically guided caudal epidural injections on patients with bilateral radicular pain from degenerative lumbar spinal stenosis.
To evaluate the therapeutic benefit of fluoroscopically guided caudal epidural steroid injections in the treatment of bilateral radicular pain from symptomatic Degenerative Lumbar Spinal Stenosis (DLSS).
This prospective cohort study was performed on 34 patients with bilateral radicular pain from lumbar spinal stenosis who received fluoroscopically guided caudal epidural injections at a multidisciplinary spine center as they did not improve with conservative care. The patients' degenerative lumbar spinal stenosis was confirmed by magnetic resonance imaging and classified as mild, moderate, or severe. The patients were evaluated by an independent observer and completed questionnaires, prior to initial injection, at 6 weeks, 6 months and 12 months after the injections.
Visual analog scale, patient satisfaction scale, standing/walking tolerance scale and Oswestry low back pain disability questionnaire.
A total of 34 patients met our inclusion criteria and were followed at 6 weeks, 6 months, and 12 months. Sixty-five percent of patients at 6 weeks, 62% at 6 months, and 54% at 12 months had a successful outcome, reporting at least a >50% reduction between pre-injection and post injection visual analog pain scores. Fifty nine percent of patients had an improved walking tolerance at 6 weeks (p <0.0001), 56% at 6 months (p <0.0001), and 51% at 12 months (p=0.0005). Fifty percent of patients had an improved standing tolerance at 6 weeks (p= 0.0002), 54% at 6 months (p < 0.0001), and 51% at 12 months (p=0.0005). The patient satisfaction scale revealed 64% of patients felt completely or somewhat better at 6 weeks, 59% at 6 months and 52% at 12 months. Owestry low back pain disability questionnaire scores showed statistically significant improvement from initial scores to 6 weeks (p < 0.0001), initial to 6 months (p= 0.0095), and initial to 12 months (p=0.00015). The outcome was statistically significant even in severe stenotic patients when comparing initial mean scores to 12 month mean scores in standing tolerance (p =0.2956), walking tolerance (p=0.0250), and VAS (p= 0.0199).
Fluoroscopically guided caudal epidural steroid injections may help reduce bilateral radicular pain and improve standing and walking tolerance in patients with DLSS.
骶管硬膜外类固醇注射常用于帮助减轻腰椎管狭窄症中的神经根性疼痛。已有研究对非透视引导下该操作的有效性进行了评估。检索发现，尚无前瞻性研究评估透视引导下骶管硬膜外注射对退行性腰椎管狭窄症所致双侧神经根性疼痛患者的有效性。
评估透视引导下骶管硬膜外类固醇注射治疗有症状的退行性腰椎管狭窄症（DLSS）所致双侧神经根性疼痛的治疗效果。
本前瞻性队列研究针对34例因腰椎管狭窄症导致双侧神经根性疼痛的患者开展，这些患者在一家多学科脊柱中心接受了透视引导下的骶管硬膜外注射，因为他们经保守治疗后病情未改善。患者的退行性腰椎管狭窄症经磁共振成像确诊，并分为轻度、中度或重度。在初次注射前、注射后6周、6个月和12个月，由一名独立观察者对患者进行评估并完成问卷调查。
视觉模拟量表、患者满意度量表、站立/行走耐受量表和Oswestry下腰痛残疾问卷。
共有34例患者符合纳入标准，并在6周、6个月和12个月时接受随访。6周时65%的患者、6个月时62%的患者以及12个月时54%的患者治疗成功，报告注射前与注射后视觉模拟疼痛评分至少降低了50%以上。6周时59%的患者行走耐受能力有所改善（p<0.0001），6个月时为56%（p<0.0001），12个月时为51%（p=0.0005）。6周时50%的患者站立耐受能力有所改善（p=0.0002），6个月时为54%（p<0.0001），12个月时为51%（p=0.0005）。患者满意度量表显示，6周时64%的患者感觉完全或有所好转，6个月时为59%，12个月时为52%。Oswestry下腰痛残疾问卷评分显示，从初始评分到6周（p<0.0001）、初始评分到6个月（p=0.0095）以及初始评分到12个月（p=0.00015）均有统计学意义上的显著改善。即使在重度狭窄患者中，将初始平均评分与12个月时的平均评分在站立耐受能力（p =0.2956）、行走耐受能力（p=0.0250）和视觉模拟量表（VAS）（p= 0.0199）方面进行比较，结果仍具有统计学意义。
透视引导下骶管硬膜外类固醇注射可能有助于减轻DLSS患者的双侧神经根性疼痛，并改善其站立和行走耐受能力。
