Kwon Jong Won, Kim Sang Jun
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Back Musculoskelet Rehabil. 2018 Feb 6;31(1):75-83. doi: 10.3233/BMR-169674.
A prospective observational comparative study.
Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection.
To determine whether spread of a lidocaine and triamcinolone mixture over the stenotic areas improves clinical symptom of spinal stenosis more effectively.
Twenty-four patients with lumbar spinal stenosis were enrolled in this study. A lumbar inter-laminar epidural injection under fluoroscopic guidance was administered to each patient. A numeric rating scale (NRS), claudication distance, the Romberg test, and the Oswestry Disability Index (ODI) were checked pre-injection and at 2, 6, and 12 weeks after the epidural injection. Vertebrae that showed more than moderate stenosis were considered stenosis levels. Inter-laminar epidural injection was performed with radiopaque contrast and lidocaine mixed with triamcinolone acetate. When the contrast covered all of the stenosis levels, this was considered a sufficient distribution (SD) and when the contrast did not cover all stenosis levels, this was considered an insufficient distribution (ID).
At 2 weeks, percentages of NRS improvement were 71.4 (IQR, 20.2) in SD group and 50.0 (IQR, 31.4) in ID group (P= 0.02), changes in Romberg test time were 0.0 (IQR, 35.0) in SD group and -3.0 (IQR, 12.0) in ID group (P= 0.02), decreases in ODI were 9.6 (IQR, 11.2) in SD group and 0.0 (IQR, 7.8) in ID group (P= 0.02). However, these parameters were not significantly different at 6 weeks and 12 weeks. Claudication distance showed no significant group difference.
Coverage of the stenotic area by the lidocaine, triamcinolone, and contrast dye mixture during inter-laminar epidural injection was an important predictor of acute pain reduction.
一项前瞻性观察性比较研究。
由于硬膜外皮质类固醇在靠近病变部位给药时对缓解疼痛更有效，当药物覆盖所有狭窄区域时，多节段狭窄区域的腰椎管狭窄症可得到更有效的治疗。药物向病理部位的分布被认为是层间硬膜外注射有效性的一个重要因素。
确定利多卡因和曲安奈德混合物在狭窄区域的扩散是否能更有效地改善椎管狭窄的临床症状。
本研究纳入了24例腰椎管狭窄症患者。在透视引导下对每位患者进行腰椎层间硬膜外注射。在注射前以及硬膜外注射后2周、6周和12周检查数字评分量表（NRS）、跛行距离、罗姆伯格试验和奥斯维斯特残疾指数（ODI）。显示中度以上狭窄的椎体被视为狭窄节段。层间硬膜外注射采用不透X线造影剂与利多卡因混合醋酸曲安奈德进行。当造影剂覆盖所有狭窄节段时，这被视为充分分布（SD），当造影剂未覆盖所有狭窄节段时，这被视为分布不足（ID）。
在2周时，SD组NRS改善百分比为71.4（四分位间距，20.2），ID组为50.0（四分位间距，31.4）（P = 0.02）；SD组罗姆伯格试验时间变化为0.0（四分位间距，35.0），ID组为-3.0（四分位间距，12.0）（P = 0.02）；SD组ODI下降为9.6（四分位间距，11.2），ID组为0.0（四分位间距，7.8）（P = 0.02）。然而，这些参数在6周和12周时无显著差异。跛行距离在两组间无显著差异。
层间硬膜外注射期间利多卡因、曲安奈德和造影剂混合物对狭窄区域的覆盖是急性疼痛减轻的重要预测指标。
