Pain Management Center of Paducah Paducah, KY, USA.
Pain Physician. 2012 Jan-Feb;15(1):51-63.
Chronic, persistent low back and lower extremity pain is often caused by spinal stenosis. Surgery and other interventions, including epidural injections, have been used to relieve this pain. However, there is little in the medical literature to support interlaminar, or transforaminal epidural injections under fluoroscopy for managing lumbar pain of central spinal stenosis, while the caudal epidural approach has been studied.
A randomized, double-blind, active, control trial.
A private, interventional pain management practice, specialty referral center in the United States.
This study sought to determine if low back and lower extremity pain secondary to lumbar central stenosis can be managed and long-lasting pain relief can be achieved with interlaminar epidural injections of local anesthetic, with or without steroids.
The study comprised 2 groups: one that received local anesthetic only and another received local anesthetic combined with nonparticulate betamethasone. A total of 120 patients were randomized by a computer-generated random allocations sequence to one of the 2 groups. The results of 30 patients in each group were assessed.
Sixty patients were included in this analysis. Outcomes measurements were taken at baseline and at 3, 6, and 12 months post-treatment. Measurements taken were Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status and opioid intake. A decrease in both the NRS and ODI of >/= 50% was considered significant.
Significant pain relief and improvement in ODI scores were seen in both groups at 12 months. Group I's significant pain relief was 70%; Group II's was 63%. The significant ODI improvement in Group I was 70%; in Group II it was 60%. Group I patients on average received 3.8 procedures a year; Group II patients received 4.0 procedures a year in successful group. Over 52 weeks in the successful group, total relief for Group I was 40.8 ± 11.7 weeks; for Group II it was 37.1 ± 12.6 weeks. Combined pain relief and functional status improvement were seen in 80% of patients in Group I and 72% in Group II in successful group.
The lack of a placebo group and preliminary results are limitations.
Patients might benefit from receiving lumbar interlaminar injections with or without steroids for lumbar central spinal stenosis.
NCT00681447.
慢性、持续性的腰背和下肢疼痛通常由椎管狭窄引起。手术和其他干预措施，包括硬膜外注射，已被用于缓解这种疼痛。然而，医学文献中几乎没有支持在透视引导下进行经椎间孔硬膜外注射治疗中央型椎管狭窄引起的腰痛的证据，而骶管硬膜外注射已经得到了研究。
一项随机、双盲、阳性对照临床试验。
美国一家私人介入性疼痛管理诊所，专业转诊中心。
本研究旨在确定对于腰椎中央型狭窄引起的腰背和下肢疼痛，经皮椎间孔硬膜外注射局部麻醉药是否可以缓解疼痛，并能长期缓解疼痛，同时还观察了局部麻醉药联合非颗粒性倍他米松的效果。
研究包括两组：一组仅接受局部麻醉，另一组接受局部麻醉联合非颗粒性倍他米松。共 120 名患者通过计算机生成的随机分配序列随机分为两组。每组有 30 名患者接受评估。
60 名患者纳入本分析。在治疗后 3、6 和 12 个月时进行结果测量。测量指标包括数字评分量表（NRS）、Oswestry 残疾指数 2.0（ODI）、就业状况和阿片类药物摄入量。NRS 和 ODI 评分均下降>/=50%被认为具有显著意义。
两组患者在治疗 12 个月时均出现显著的疼痛缓解和 ODI 评分改善。组 I 的显著疼痛缓解率为 70%；组 II 的为 63%。组 I 的显著 ODI 改善率为 70%；组 II 的为 60%。组 I 患者平均每年接受 3.8 次治疗；组 II 患者每年在成功组中接受 4.0 次治疗。在成功组的 52 周内，组 I 的总缓解率为 40.8±11.7 周；组 II 的为 37.1±12.6 周。在成功组中，80%的组 I 患者和 72%的组 II 患者同时出现疼痛缓解和功能状态改善。
缺乏安慰剂组和初步结果是本研究的局限性。
对于腰椎中央型脊柱狭窄症患者，接受腰椎间孔硬膜外注射治疗（联合或不联合类固醇）可能会获益。
NCT00681447。
