Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
AJNR Am J Neuroradiol. 2013 Jan;34(1):239-46. doi: 10.3174/ajnr.A3170. Epub 2012 Jul 5.
Interlaminar LESIs are commonly used to treat LBP or radiculopathy. Most studies focus on the long-term outcomes of LESI. The purpose of this study is to evaluate the immediate effects of fluoroscopically guided LESI on LBP/radiculopathy including low- or high-strength anesthetic response.
The procedure notes, post-procedure records, and imaging records dedicated spine nurse assessments, and imaging records were retrospectively evaluated in 392 fluoroscopically guided LESIs performed in 276 patients (nonrandomized, nonblinded; 131 males, 145 females; average age, 56 years) with LBP/radiculopathy using either low- or high-strength anesthetic (80 mg of methylprednisilone mixed with bupivacaine [0.25% or 0.5%]). Post-procedure documentation of the patient's pre- and postprocedure VAS pain-scale level were tabulated.
Single LESI was performed in 199 patients, with multiple LESIs in 77 (193 injections). Low-strength bupivacaine (0.25%) was used in 237 injections, with high-strength (0.5%) in 155. Complete to near-complete immediate pain relief (<20% residual pain) was reported after 197 of 392 (50.3%) injections. No pain relief was reported after 60 (15.4%) injections (>80% residual), with partial relief in the remainder. No statistical difference was noted between low- and high-anesthetic strength or between single- and multiple-injection patients. In multiple-LESI patients, consistent pain relief response was noted in 39 of 77 (50.6%) patients, with improving LESI response in 20.8%, deteriorating LESI response in 19.5%, and variable response in 9.1%.
An immediate pain-extinction response is identified after LESI, which appears independent of anesthetic strength. This observation may relate to pain origin and/or pain nociceptor afferent pathway in an individual patient and potentially relate to treatment response.
经皮椎间孔内镜下腰椎间孔神经松解术（LESIs）常用于治疗腰痛或神经根病变。大多数研究都集中在 LESI 的长期疗效上。本研究旨在评估在 X 线透视引导下进行 LESI 对腰痛/神经根病变的即刻疗效，包括低强度和高强度麻醉反应。
回顾性分析 276 例腰痛/神经根病变患者（非随机、非盲法；男 131 例，女 145 例；平均年龄 56 岁）392 次 X 线透视引导 LESI 治疗的手术记录、术后记录、专用脊柱护士评估和影像学记录。采用低强度（80mg 甲泼尼龙混合布比卡因[0.25%或 0.5%]）或高强度麻醉（80mg 甲泼尼龙混合布比卡因[0.25%或 0.5%]）进行 LESI。将患者术前和术后 VAS 疼痛量表的评分记录制成表格。
199 例患者行单次 LESI，77 例患者行多次 LESI（193 次注射）。237 次注射采用低强度布比卡因（0.25%），155 次注射采用高强度布比卡因（0.5%）。392 次注射中有 197 次（50.3%）报告完全或接近完全即刻疼痛缓解（<20%残留疼痛）。60 次（15.4%）报告无疼痛缓解（>80%残留），其余患者部分缓解。低强度和高强度麻醉、单次和多次注射患者之间无统计学差异。在多次 LESI 患者中，77 例患者中有 39 例（50.6%）患者的疼痛缓解反应一致，20.8%的患者 LESI 反应改善，19.5%的患者 LESI 反应恶化，9.1%的患者反应不稳定。
LESIs 后即刻出现疼痛消失反应，似乎与麻醉强度无关。这种观察结果可能与个体患者的疼痛起源和/或疼痛伤害感受器传入通路有关，并可能与治疗反应有关。
