Singh Sudhir, Kumar Sanjiv, Chahal Gaurav, Verma Reetu
Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospital, Lucknow, UP, India.
Associate Professor, Department of Orthopaedics, Era's Lucknow Medical College & Hospital, Lucknow, UP, India.
J Clin Orthop Trauma. 2017 Apr-Jun;8(2):142-147. doi: 10.1016/j.jcot.2016.02.001. Epub 2016 Feb 22.
Chronic lumbar radiculopathy has a lifetime prevalence of 5.3% in men and 3.7% in women. It usually resolves spontaneously, but up to 30% cases will have pronounced symptoms even after one year.
A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and selective nerve root block in management of pain and disability in cases of lumbar disc herniation.
Eighty patients with confirmed single-level lumbar disc herniation were equally divided in two groups: (a) caudal epidural and (b) selective nerve root block group, by a computer-generated random allocation method. The caudal group received three injections of steroid mixed with local anesthetics while selective nerve root block group received single injection of steroid mixed with local anesthetic agent. Patients were assessed for pain relief and reduction in disability.
In SNRB group, pain reduced by more than 50% up till 6 months, while in caudal group more than 50% reduction of pain was maintained till 1 year. The reduction in ODI in SNRB group was 52.8% till 3 months, 48.6% till 6 months, and 46.7% at 1 year, while in caudal group the improvement was 59.6%, 64.6%, 65.1%, and 65.4% at corresponding follow-up periods, respectively.
Caudal epidural block is an easy and safe method with better pain relief and improvement in functional disability than selective nerve root block. Selective nerve root block injection is technically more demanding and has to be given by a skilled anesthetist.
慢性腰椎神经根病在男性中的终生患病率为5.3%，在女性中为3.7%。它通常会自发缓解，但高达30%的病例即使在一年后仍会有明显症状。
进行一项前瞻性随机单盲研究，比较骶管硬膜外类固醇注射和选择性神经根阻滞在治疗腰椎间盘突出症患者疼痛和功能障碍方面的疗效。
80例确诊为单节段腰椎间盘突出症的患者通过计算机生成的随机分配方法平均分为两组：（a）骶管硬膜外组和（b）选择性神经根阻滞组。骶管组接受三次类固醇与局部麻醉剂混合注射，而选择性神经根阻滞组接受一次类固醇与局部麻醉剂混合注射。对患者的疼痛缓解和功能障碍减轻情况进行评估。
在选择性神经根阻滞组，直至6个月疼痛减轻超过50%，而在骶管组，超过50%的疼痛减轻持续至1年。选择性神经根阻滞组的ODI（腰椎功能障碍指数）在3个月时降低52.8%，6个月时降低48.6%，1年时降低46.7%，而在骶管组，相应随访期的改善分别为59.6%、64.6%、65.1%和65.4%。
骶管硬膜外阻滞是一种简单安全的方法，与选择性神经根阻滞相比，在缓解疼痛和改善功能障碍方面效果更好。选择性神经根阻滞注射在技术上要求更高，必须由熟练的麻醉师进行操作。
