Jeon Chang-Hoon, Lee Yu-Sang, Lee Han-Dong, Chung Nam-Su
*Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; and †Department of Orthopaedic Surgery, Bumin Hospital, Busan, Republic of Korea.
Spine (Phila Pa 1976). 2015 May 15;40(10):719-24. doi: 10.1097/BRS.0000000000000833.
STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To evaluate the safety and efficacy of the ventral epidural filling technique in lumbar interlaminar epidural steroid injection (ESI). SUMMARY OF BACKGROUND DATA: The ventral epidural space can be a preferred target in ESI because it contains many spinal pain generators. However, there have been few studies regarding the ventral epidural space filling technique in interlaminar ESI. METHODS: This study involved a retrospective analysis of 150 consecutive patients treated with the ventral epidural filling technique in interlaminar ESI (ventral ESI) and a control cohort of 150 consecutive patients treated with the dorsal epidural filling technique in interlaminar ESI (conventional ESI). The visual analogue scale for leg pain, the visual analogue scale for back pain, and the Oswestry Disability Index were compared at preinjection and 2 weeks, 6 weeks, 6 months, and 1 year postinjection. The groups were compared with regard to repeated injection or surgery within 1 year after the initial procedure. The fluoroscopic time and the procedure-related complications including severe pain (visual analogue scale score>7) during injection, dural puncture (subdural contrast spread), headache, neurological symptoms, and infection were also compared. RESULTS: There were no significant differences in leg pain, back pain, or Oswestry Disability Index improvement at each visit between the ventral ESI group and the conventional ESI group (all P>0.05). The numbers of repeat injections and surgical procedures were not significantly different between 2 groups (P=0.262 and 0.385, respectively). There were no significant differences in severe pain at injection (P=0.326), dural puncture (P=0.428), headache (P=0.393), neurological symptom (P=0.419), or infection (P=0.500) between the 2 groups. The fluoroscopic time was significantly shorter in ventral than in conventional ESI (P<0.000). CONCLUSION: The ventral epidural filling technique can be performed safely and more easily during lumbar interlaminar ESI. The clinical results and procedure-related complications with this technique were comparable with those seen with conventional interlaminar ESI. LEVEL OF EVIDENCE: 3.
研究设计：一项回顾性病例对照研究。 目的：评估腰椎椎间孔硬膜外类固醇注射（ESI）中腹侧硬膜外填充技术的安全性和有效性。 背景数据总结：腹侧硬膜外间隙可能是ESI的首选靶点，因为它包含许多引起脊柱疼痛的因素。然而，关于椎间孔ESI中腹侧硬膜外间隙填充技术的研究很少。 方法：本研究对150例连续接受椎间孔ESI腹侧硬膜外填充技术治疗的患者（腹侧ESI组）和150例连续接受椎间孔ESI背侧硬膜外填充技术治疗的患者（传统ESI组）进行回顾性分析。比较注射前、注射后2周、6周、6个月和1年时的腿痛视觉模拟评分、背痛视觉模拟评分和Oswestry功能障碍指数。比较两组在初次手术后1年内重复注射或手术的情况。还比较了透视时间以及与操作相关的并发症，包括注射期间的剧痛（视觉模拟评分>7）、硬膜穿刺（硬膜下造影剂扩散）、头痛、神经症状和感染。 结果：腹侧ESI组和传统ESI组在每次随访时腿痛、背痛或Oswestry功能障碍指数改善方面无显著差异（所有P>0.05）。两组间重复注射次数和手术例数无显著差异（分别为P = 0.262和0.385）。两组在注射时的剧痛（P = 0.326）、硬膜穿刺（P = 0.428）、头痛（P = 0.393）、神经症状（P = 0.419）或感染（P = 0.500）方面无显著差异。腹侧ESI的透视时间明显短于传统ESI（P<0.000）。 结论：在腰椎椎间孔ESI过程中，腹侧硬膜外填充技术可以安全、更容易地实施。该技术的临床结果和与操作相关的并发症与传统椎间孔ESI相当。 证据级别：3级。
Spine (Phila Pa 1976). 2015-5-15
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