Farooque Mustafa, Salzman Michele M, Ye Zhan
Aurora Back and Spine Program, Aurora St. Luke's Medical Center, 2901 W. Kinnickinnic River Parkway, Suite 106, Milwaukee, WI 53215(∗).
Department of Anesthesiology, Vanderbilt University Medical Center, and Department of Pharmacology, Vanderbilt University, Nashville, TN(†).
PM R. 2017 Jan;9(1):26-31. doi: 10.1016/j.pmrj.2016.06.002. Epub 2016 Jun 10.
As our population ages, neurogenic claudication (NC) from central canal stenosis of the lumbar spine is becoming an increasingly common condition. Studies have been undertaken to assess the efficacy of caudal, interlaminar, or unilateral transforaminal epidural injections, but bilateral transforaminal epidural injections (BTESIs) have not been evaluated to date.
To assess the therapeutic value and long-term effects of fluoroscope-guided BTESIs in patients with NC from degenerative lumbar spinal stenosis (DLSS) of the central spinal canal.
Case series.
Single institution spine clinic.
Twenty-six adults between the ages of 40 and 90 years with a diagnosis of DLSS and a history of subacute or chronic NC.
METHODS/INTERVENTIONS: Patients meeting inclusion criteria received fluoroscope-guided BTESI of local anesthetic and steroid at the level immediately below the most stenotic level. Patient self-reported pain level, activity level, and overall satisfaction were recorded by telephone interview at 1, 3, and 6 months after injection by an independent observer.
Pain score and Swiss Spinal Stenosis score at baseline, 1, 3, and 6 months.
Of the 22 participants eligible for analysis, 20, 19, and 18 had follow-up data available at 1, 3, and 6 months, respectively. Reduction in numeric pain scale score of at least 50% was noted in 30% of participants at 1 month, 53% at 3 months, and 44% at 6 months. Swiss Spinal Stenosis subscale scores indicated a significant reduction in the proportion of participants reporting the presence of severe pain in the back, buttocks, and legs (particularly the back or buttocks) at 1, 3, and 6 months of follow-up compared with baseline (P < .05). The proportion of participants reporting severe weakness in the legs or feet also decreased after injection and was statistically significant at 3 months of follow-up (P = .04).
Fluoroscope-guided BTESI was moderately effective in reducing pain, improving function, and achieving patient satisfaction in patients with NC from DLSS at the central spinal canal in this clinical case series.
IV.
随着人口老龄化，腰椎中央管狭窄所致神经源性间歇性跛行（NC）愈发常见。已有研究评估了骶管、椎板间或单侧经椎间孔硬膜外注射的疗效，但双侧经椎间孔硬膜外注射（BTESI）迄今尚未得到评估。
评估在X线透视引导下对患有中央椎管退变性腰椎狭窄（DLSS）的NC患者进行BTESI的治疗价值和长期效果。
病例系列。
单机构脊柱诊所。
26例年龄在40至90岁之间、诊断为DLSS且有亚急性或慢性NC病史的成年人。
方法/干预措施：符合纳入标准的患者在最狭窄节段下方紧邻的节段接受了在X线透视引导下的局部麻醉药和类固醇的BTESI。在注射后1、3和6个月，由独立观察者通过电话访谈记录患者自我报告的疼痛程度、活动水平和总体满意度。
基线、1、3和6个月时的疼痛评分和瑞士脊柱狭窄评分。
在22名符合分析条件的参与者中，分别有20、19和18名在1、3和6个月时有随访数据。1个月时，30%的参与者数字疼痛量表评分降低至少50%，3个月时为53%，6个月时为44%。瑞士脊柱狭窄子量表评分显示，与基线相比，在随访1、3和6个月时，报告背部、臀部和腿部（尤其是背部或臀部）存在严重疼痛的参与者比例显著降低（P <.05）。报告腿部或足部严重无力的参与者比例在注射后也有所下降，在随访3个月时具有统计学意义（P = 0.04）。
在此临床病例系列中，在X线透视引导下的BTESI对于减轻患有中央椎管DLSS的NC患者的疼痛、改善功能并实现患者满意度具有中等效果。
四级。
