Kanayama Masahiro, Oha Fumihiro, Hashimoto Tomoyuki
Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan,
Int Orthop. 2015 Jul;39(7):1379-82. doi: 10.1007/s00264-015-2761-3. Epub 2015 Apr 16.
Peri-radicular injection is a widely used procedure for treating lumbar radicular pain, but it remains unclear what types of lumbar pathologies respond well to this treatment. We aimed to investigate the efficacy of peri-radicular injection for degenerative lumbar disorders and to determine what types of pathologies respond well to this treatment.
We reviewed the records of 641 consecutive patients who underwent peri-radicular injection for degenerative lumbar pathologies with mean follow-up of 23.4 months. The pathologies included herniated disc in 286 patients, spinal stenosis in 141, degenerative spondylolisthesis in 136, failed back surgery in 24, isthmic spondylolisthesis in 22, degenerative scoliosis in 18, and foraminal stenosis in 14. Outcome measure was whether or not surgery is avoided by using peri-radicular injection. The rate of obviating surgery was determined in each pathology.
Peri-radicular injection obviated surgeries in 331 patients (51.7%). There were no complications related to the procedure, including neurological deterioration, infection, and haematoma. The rate of obviating surgery was 42.0% in disc herniation, 52.9% in degenerative spondylolisthesis, 67.4% in spinal stenosis, 54.5% in isthmic spondylolisthesis, 57.1% in foraminal stenosis, 61.1% in degenerative scoliosis and 54.1% in failed back surgery. Poor outcomes were observed in herniated disc with spinal stenosis (17.9% success), foraminal disc herniation (33.3%), recurrent disc herniation (18.2%) and failed back surgery with instability (33.3%).
This study demonstrated that 51.7% of patients with degenerative lumbar pathologies were successfully treated by peri-radicular injection. Efficacy was limited in cases of herniated disc with spinal stenosis, foraminal disc herniation, recurrent disc herniation and failed back surgery with instability.
神经根周围注射是治疗腰椎神经根性疼痛的一种广泛应用的方法，但目前尚不清楚哪种类型的腰椎病变对该治疗反应良好。我们旨在研究神经根周围注射治疗退行性腰椎疾病的疗效，并确定哪种类型的病变对该治疗反应良好。
我们回顾了641例连续接受神经根周围注射治疗退行性腰椎病变患者的记录，平均随访23.4个月。病变包括286例椎间盘突出症、141例椎管狭窄症、136例退行性椎体滑脱症、24例腰椎手术失败综合征、22例峡部裂性椎体滑脱症、18例退行性脊柱侧凸症和14例椎间孔狭窄症。观察指标为通过神经根周围注射是否避免了手术。确定每种病变避免手术的比例。
神经根周围注射使331例患者（51.7%）避免了手术。未出现与该操作相关的并发症，包括神经功能恶化、感染和血肿。椎间盘突出症避免手术的比例为42.0%，退行性椎体滑脱症为52.9%，椎管狭窄症为67.4%，峡部裂性椎体滑脱症为54.5%，椎间孔狭窄症为57.1%，退行性脊柱侧凸症为61.1%，腰椎手术失败综合征为54.1%。在合并椎管狭窄的椎间盘突出症（成功率17.9%）、椎间孔型椎间盘突出症（33.3%）、复发性椎间盘突出症（18.2%）和伴有不稳的腰椎手术失败综合征（33.3%）中观察到较差的结果。
本研究表明，51.7%的退行性腰椎病变患者通过神经根周围注射得到了成功治疗。在合并椎管狭窄的椎间盘突出症、椎间孔型椎间盘突出症、复发性椎间盘突出症和伴有不稳的腰椎手术失败综合征病例中，疗效有限。
