Ökmen Korgün, Ökmen Burcu Metin
Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah, Emniyet Street, Yıldırım, Bursa 16260, Turkey.
Physical Medicine and Rehabilitation, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah, Emniyet Street, Yıldırım, Bursa 16260, Turkey.
Spine J. 2017 Feb;17(2):168-174. doi: 10.1016/j.spinee.2016.08.024. Epub 2016 Aug 20.
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).
A randomized controlled trial was performed.
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.
The LA group (Group L, n=50) received 10 mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10 mL 0.25% bupivacaine+40 mg methylprednisolone at L4-L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid.
硬膜外类固醇注射常用于慢性下腰痛患者。采用椎板间（IL）、经椎间孔和骶管技术应用局部麻醉剂（LA）和类固醇的混合物是一种首选方法。
本研究旨在探讨椎板间硬膜外类固醇给药对多节段腰椎间盘病变（LDP）患者的疗效，并评估该手术成功率与年龄和体重指数（BMI）之间的可能相关性。
进行了一项随机对照试验。
我们对总共98例多节段LDP患者进行了椎板间硬膜外类固醇注射。
在治疗前（PRT）、治疗后以及治疗后1、3、6和12个月对研究人群进行视觉模拟量表（VAS）和奥斯维斯特功能障碍指数（ODI）评分。评估BMI和年龄与手术成功率之间的可能相关性。
局部麻醉剂组（L组，n = 50）在C形臂荧光透视引导下俯卧位，于L4-L5椎间隙接受10 mL 0.25%布比卡因，而类固醇+局部麻醉剂组（S组，n = 48）接受10 mL 0.25%布比卡因+40 mg甲泼尼龙。
两组治疗前VAS和ODI评分无统计学差异（p < .05），而治疗后1、3、6和12个月时，L组的VAS和ODI评分高于S组（p < .05）。未发现年龄和BMI与手术成功率相关。
我们的研究结果表明，接受类固醇治疗的多节段LDP患者在进行IL硬膜外注射后，VAS和ODI评分较低。然而，需要进一步研究以就IL硬膜外注射在硬膜外区域的分布情况和类固醇剂量得出确凿结论。
