Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.
Departments of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
Curr Pain Headache Rep. 2019 Feb 22;23(2):14. doi: 10.1007/s11916-019-0748-2.
The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit.
Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.
随着老年患者人群的增加，腰椎管狭窄症导致的严重疼痛和功能丧失的治疗需求很高。包括硬膜外类固醇注射（ESI）和药物治疗在内的治疗方法选择有限，并且尚不清楚这些方法是否能提供任何功能改善。在这项前瞻性研究中，我们通过引入简短体能状况评估量表（SPPB），评估了接受 ESI 治疗的有症状腰椎管狭窄症老年患者与接受药物治疗的患者的功能结果。我们的研究得到了机构审查委员会的批准，纳入了 16 名年龄在 68 至 83 岁之间的患者，这些患者均患有与腰椎管狭窄症相关的腰痛和神经根性腿痛。患者可以选择接受腰椎 ESI（n = 11）或药物治疗（n = 5）。在基线和 1 个月随访时测量并比较了数字疼痛评分、SPPB 评分和不良事件。
与基线相比，注射组的总 SPPB 评分在 1 个月随访时具有统计学显著改善。注射组在疼痛评分和 SPPB 子成分（如 4 米步行测试、椅立时间和平衡评分）方面也观察到类似的改善。相比之下，药物组没有观察到统计学上显著的改善。与药物治疗相比，腰椎 ESI 改善了有症状的老年腰椎管狭窄症患者的客观身体能力参数和疼痛评分。此外，SPPB 是一种用于测量老年人身体功能变化的简单易用的工具，并且可以轻松地整合到门诊疼痛诊所中。
