Koc Zarife, Ozcakir Suheda, Sivrioglu Koncuy, Gurbet Alp, Kucukoglu Selcuk
Department of Physical Medicine and Rehabilitation, Uludag University School of Medicine, Bursa, Turkey.
Spine (Phila Pa 1976). 2009 May 1;34(10):985-9. doi: 10.1097/BRS.0b013e31819c0a6b.
Randomized single-blind controlled trial.
We aimed to compare the effects of epidural steroid injections and physical therapy program on pain and function in patients with lumbar spinal stenosis (LSS).
LSS is one of the most common degenerative spinal disorders among elderly population. Initial treatment of this disabling painful condition is usually conservative including analgesics, nonsteroidal anti-inflammatory drugs, exercise, physical therapy, or epidural steroid injections. Owing to lack of sufficient data concerning the effectiveness of conservative treatment in LSS, we aimed to compare the effectiveness of epidural steroid injections and physical therapy program in a randomized controlled manner.
A total of 29 patients diagnosed as LSS were randomized into 3 groups. Group 1 (n = 10) received an inpatient physical therapy program for 2 weeks, group 2 (n = 10) received epidural steroid injections, and group 3 (n = 9) served as the controls. All study patients additionally received diclofenac and a home-based exercise program. The patients were evaluated at baseline, 2 weeks, 1 month, 3 months, and 6 months after treatment by finger floor distance, treadmill walk test, sit-to-stand test, weight carrying test, Roland Morris Disability Index, and Nottingham Health Profile.
Both epidural steroid and physical therapy groups have demonstrated significant improvement in pain and functional parameters and no significant difference was noted between the 2 treatment groups. Significant improvements were also noted in the control group. Pain and functional assessment scores (RMDI, NHP physical activity subscore) were significantly more improved in group 2 compared with controls at the second week.
Epidural steroid injections and physical therapy both seem to be effective in LSS patients up to 6 months of follow-up.
随机单盲对照试验。
我们旨在比较硬膜外类固醇注射和物理治疗方案对腰椎管狭窄症（LSS）患者疼痛和功能的影响。
LSS是老年人群中最常见的退行性脊柱疾病之一。这种导致残疾的疼痛性疾病的初始治疗通常是保守治疗，包括使用镇痛药、非甾体抗炎药、运动、物理治疗或硬膜外类固醇注射。由于缺乏关于LSS保守治疗有效性的充分数据，我们旨在以随机对照的方式比较硬膜外类固醇注射和物理治疗方案的有效性。
总共29名被诊断为LSS的患者被随机分为3组。第1组（n = 10）接受为期2周的住院物理治疗方案，第2组（n = 10）接受硬膜外类固醇注射，第3组（n = 9）作为对照组。所有研究患者额外接受双氯芬酸和家庭锻炼方案。在治疗后的基线、2周、1个月、3个月和6个月，通过手指到地面距离、跑步机行走测试、从坐到站测试、负重测试、罗兰·莫里斯残疾指数和诺丁汉健康概况对患者进行评估。
硬膜外类固醇组和物理治疗组在疼痛和功能参数方面均有显著改善，且两个治疗组之间未发现显著差异。对照组也有显著改善。在第2周时，与对照组相比，第2组的疼痛和功能评估评分（RMDI、NHP身体活动子评分）有更显著的改善。
在长达6个月的随访中，硬膜外类固醇注射和物理治疗对LSS患者似乎都有效。
