Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, 38030, Kayseri, Turkey.
Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, 34906, Istanbul, Turkey.
Skeletal Radiol. 2019 Jul;48(7):1051-1058. doi: 10.1007/s00256-018-3129-8. Epub 2019 Jan 2.
To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.
We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. The patients were assessed using the Numerical Rating Scale, the Modified Oswestry Disability Index, and the Beck Depression Inventory before the injection and at hour 1, week 3, and month 3 after the injection. Presence of facet tropism was assessed by measuring the facet angles in the L3-4, L4-5, and L5-S1 segments of lumbar MRI T2 sequence axial section.
A significant decrease in the Numerical Rating Scale and an increase in the Modified Oswestry Disability Index scores were detected at all follow-ups in groups comprising 39 patients with and 61 without facet tropism (p < 0.05). On comparison, improvement in clinical parameters at week 3 and month 3 in the group without facet tropism was greater (p < 0.05). As treatment success is considered to be a ≥ 50% reduction in the Numerical Rating Scale scores, 55.2% of the patients attained treatment success at month 3. Further, although the treatment success rate in the group with facet tropism was 34.2%, it was 69% in that without facet tropism (p < 0.05).
Facet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure.
探讨小关节偏斜对腰椎间盘突出症单侧根性疼痛经皮椎间孔硬膜外类固醇注射治疗效果的影响。
纳入 112 例单侧单节段腰椎间盘突出症所致单侧根性疼痛患者。计划在相关水平进行注射。患者在注射前、注射后 1 小时、3 周和 3 个月分别采用数字评分量表（NRS）、改良 Oswestry 功能障碍指数（ODI）和贝克抑郁量表（BDI）进行评估。通过测量腰椎 MRI T2 序列轴位 L3-4、L4-5 和 L5-S1 节段小关节角来评估小关节偏斜的存在。
在包含 39 例存在小关节偏斜和 61 例不存在小关节偏斜的两组中，所有随访时 NRS 评分均显著降低，ODI 评分均显著升高（p<0.05）。相比之下，无小关节偏斜组在 3 周和 3 个月时临床参数的改善更为显著（p<0.05）。如果认为治疗成功是 NRS 评分至少降低 50%，则 3 个月时 55.2%的患者达到了治疗成功。进一步分析，尽管存在小关节偏斜组的治疗成功率为 34.2%，但无小关节偏斜组的治疗成功率为 69%（p<0.05）。
小关节偏斜与经皮椎间孔硬膜外类固醇注射治疗效果较差相关；因此，小关节偏斜可能是与患者讨论该治疗益处时的一个有价值的测量指标。
