Department of Neurosurgery, Baskent University, Istanbul, Turkey.
Department of Neurosurgery, Baskent University, Ankara, Turkey.
Neurol India. 2018 Jan-Feb;66(1):90-95. doi: 10.4103/0028-3886.222850.
Epidural steroid injection is widely used to treat the short and long-term symptoms of low back and radicular pain. To the best of our knowledge, the influence of transforaminal epidural steroid injection (TFSI) combined with caudal epidural steroid injection (CESI) on pain intensity, patient satisfaction, and quality of life in lumbar radiculopathy has not been examined.
To evaluate the short and long-term efficacy of TFSI, and TFSI combined with CESI (TFSI + CESI) in patients with lumbar radiculopathy.
We retrospectively examined the records of 104 patients with lumbar radicular pain and L4/5 and/or L5/S1 intervertebral disc disease who underwent TFSI or TFSI + CESI. We compared the pain intensity using a Visual Numeric Scale (VNS), North American Spine Society (NASS) pain satisfaction index, and EuroQol five dimensions (EQ-5D) quality of life scores before intervention, and after 1, 6 and 12 months.
In the TFSI group, the mean pre-treatment VNS score was 9.2, which improved to 4.9 after 1 month and to 7.2 after 12 months. In the TFSI + CESI group, the mean pre-treatment VNS score was 9.4, which improved to 2.6 and 4.6 after 1 and 12 months, respectively. Improvement in the VNS scores was significantly higher in the TFSI + CESI group (P < 0.0001 for each). Mean EQ-5D quality of life index in the TFSI group improved from 0.59 in the pre-treatment phase to 0.76 after 12 months of intervention, while it improved from 0.62 in the pre-treatment phase to 0.84 at 12 months of intervention in the TFSI + CESI group. The EQ-5D scores were significantly better in the TFSI + CESI group at 1, 6, and 12 months after the procedure (P = 0.004, 0.036, and 0.042, for 1, 6, and 12 months, respectively). The NASS scores were significantly better in the TFSI + CESI group at 6 and 12 months after the intervention (P = 0.025 and 0.001 for 6 months and 12 months, respectively).
In patients with lower lumbar radiculopathy, a combined TFSI + CESI technique offers superior short and long-term pain relief, quality of life, and long-term patient satisfaction, than when TFSI is performed alone.
硬膜外类固醇注射被广泛用于治疗短期和长期的下腰痛和神经根痛症状。据我们所知，经椎间孔硬膜外类固醇注射（TFSI）联合骶管硬膜外类固醇注射（CESI）对腰椎神经根病的疼痛强度、患者满意度和生活质量的影响尚未被检查。
评估 TFSI 和 TFSI 联合 CESI（TFSI+CESI）在腰椎神经根病患者中的短期和长期疗效。
我们回顾性分析了 104 例因腰椎神经根痛和 L4/5 和/或 L5/S1 椎间盘疾病接受 TFSI 或 TFSI+CESI 治疗的患者的记录。我们比较了干预前、后 1、6 和 12 个月的视觉模拟评分（VNS）、北美脊柱协会（NASS）疼痛满意度指数和欧洲五维健康量表（EQ-5D）生活质量评分。
在 TFSI 组，治疗前 VNS 评分的平均值为 9.2，1 个月后降至 4.9，12 个月后升至 7.2。在 TFSI+CESI 组，治疗前 VNS 评分的平均值为 9.4，1 个月后降至 2.6，12 个月后降至 4.6。TFSI+CESI 组的 VNS 评分改善显著更高（每个 P<0.0001）。TFSI 组的 EQ-5D 生活质量指数从治疗前的 0.59 提高到 12 个月后的 0.76，而 TFSI+CESI 组则从治疗前的 0.62 提高到 12 个月后的 0.84。TFSI+CESI 组在术后 1、6 和 12 个月时的 EQ-5D 评分明显更好（分别为 P=0.004、0.036 和 0.042）。TFSI+CESI 组在干预后 6 和 12 个月的 NASS 评分明显更好（分别为 P=0.025 和 0.001）。
对于下腰痛患者，TFSI+CESI 联合技术比单独使用 TFSI 能提供更好的短期和长期缓解疼痛、提高生活质量和长期患者满意度。
