Batistaki Chrysanthi, Angelopoulou Athina, Smyrnioti Maria-Eleni, Kitsou Maria-Chrysanthi, Kostopanagiotou Georgia
2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece.
Anesth Pain Med. 2017 Dec 27;7(6):e62556. doi: 10.5812/aapm.62556. eCollection 2017 Dec.
Epidural steroid injections (ESIs) are commonly used in the management of chronic lower back and leg pain. The aim of this study was to investigate the short- and long-term electromyographic and clinical outcome of patients with chronic radicular pain after ESIs. This prospective, open-label study, included patients with chronic radicular pain due to disc herniation or spinal stenosis, who underwent interlaminar, fluoroscopy-guided ESIs. Patients were assessed before ESIs, as well as after 6 and 12 months, clinically (VAS 0-10, BPI, DN4, Rolland Morris, DASS, STAI) and electromyographically for the improvement of spontaneous activity (SA) and of motor unit recruitment/interference pattern (IP/MUR). A total of 39 patients were studied, 20 (51.3%) who had a significant improvement in VAS, RM, DN4 and BPI were revealed, mainly during the first 6 months (P < 0.05). Statistically significant improvement was revealed in MUR/SA for almost all nerve roots studied. Patients with disc herniation showed a greater improvement in mean difference of MUR/SA (P < 0.05) (with a prognostic value of radicular LBP versus spinal stenosis in short- [VAS P = 0.042] and long-term improvement of pain [VAS P = 0.009]. The independent variables "MUR" and "SA" had a significant prognostic value for improvement of pain (VAS: R = 0.287, P = 0.032 and VAS: R = 0.277, P = 0.036 respectively). Electromyographic and clinical findings indicated a benefit from epidural steroid injections. Patients with disc herniation exhibited a better outcome, especially during the first 6 months post-treatment.
硬膜外类固醇注射（ESIs）常用于慢性下背部和腿部疼痛的治疗。本研究的目的是调查硬膜外类固醇注射后慢性神经根性疼痛患者的短期和长期肌电图及临床结果。这项前瞻性、开放标签研究纳入了因椎间盘突出或椎管狭窄导致慢性神经根性疼痛且接受了椎间孔镜引导下硬膜外类固醇注射的患者。在硬膜外类固醇注射前、注射后6个月和12个月对患者进行临床评估（视觉模拟评分0 - 10分、简明疼痛量表、DN4量表、罗兰·莫里斯功能障碍问卷、抑郁焦虑压力量表、状态特质焦虑量表）以及肌电图评估，以观察自发活动（SA）和运动单位募集/干扰模式（IP/MUR）的改善情况。共研究了39例患者，其中20例（51.3%）在视觉模拟评分、罗兰·莫里斯功能障碍问卷、DN4量表和简明疼痛量表方面有显著改善，主要在最初6个月内（P < 0.05）。几乎所有研究神经根的运动单位募集/自发活动均有统计学显著改善。椎间盘突出患者的运动单位募集/自发活动平均差异改善更大（P < 0.05）（在短期[视觉模拟评分P = 0.042]和长期疼痛改善[视觉模拟评分P = 0.009]方面，神经根性腰痛与椎管狭窄具有预后价值）。自变量“运动单位募集”和“自发活动”对疼痛改善具有显著预后价值（视觉模拟评分：R = 0.287，P = 0.032；视觉模拟评分：R = 至0.277，P = 0.036）。肌电图和临床结果表明硬膜外类固醇注射有益。椎间盘突出患者的治疗效果更好，尤其是在治疗后的前6个月。
