Ibrahim Maha Emad, Awadalla Magdy Ahmed, Omar Aziza Sayed, Al-Shatouri Mohammad
Lecturer of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University. PhD in Physical Medicine, Rheumatology and Rehabilitation, Ismailia, Egypt.
Professor of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University. PD in Physical Medicine, Rheumatology and Rehabilitation, Ismailia, Egypt.
BJR Open. 2020 Jan 13;2(1):20190006. doi: 10.1259/bjro.20190006. eCollection 2020.
To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain.
Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group ( = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group ( = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion.
Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment ( > 0.05).
Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard.
This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.
评估超声引导下骶管硬膜外类固醇注射（ESIs）对慢性根性腰痛患者疼痛的短期改善效果，以及通过电生理测试测量的神经功能改善情况。
将诊断为慢性根性腰痛的患者随机分为两组。注射组（n = 20）接受单次超声引导下的骶管ESI，注射1 ml含40 mg/ml曲安奈德（得宝松）的溶液及局部麻醉剂。对照组（n = 20）接受为期12节的物理治疗方案。两组在干预前及干预后2周均使用视觉模拟评分法评估疼痛，并通过电生理测试评估，包括腓总神经和胫神经终末运动潜伏期、F波潜伏期及时间离散度。
干预后两组视觉模拟评分法均显示疼痛显著减轻。注射组治疗后F波时间离散度显著降低（P<0.01）。对照组治疗前后F波参数无显著差异（P>0.05）。
骶管ESIs显示出能在短期内改善神经功能，表现为对神经根病敏感的电生理参数得到改善。在这方面，它被发现优于标准物理治疗。
这项工作展示了超声引导下骶管ESI短期疗效的新电生理证据。
