He Yubao, Chen Lei, Xu Zhiyang, Wang Jieying, Liu Bo
Department of Orthopedics, Beijing Chuiyangliu Hospital, Beijing 100022, China.
Department of Spinal Surgery, Jishuitan Hospital, Beijing 100035, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Dec 30;40(12):1804-1809. doi: 10.12122/j.issn.1673-4254.2020.12.16.
To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.
We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.
The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (=2.224, =0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (=1.743, =0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients ( < 0.001), and such improvements became more obvious over time after LTEB ( < 0.01).
As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.
评估腰椎经椎间孔硬膜外阻滞(LTEB)治疗伴有神经根性疼痛的下腰痛的疗效。
回顾性分析2017年3月至2019年4月在北京垂杨柳医院骨科住院的78例伴有神经根性疼痛的下腰痛患者的临床资料。其中33例患者接受LTEB治疗(LTEB组),45例患者接受包括牵引、按摩、针灸和理疗在内的综合保守治疗(对照组)。比较两组的人口统计学和临床资料。对患者进行3至24个月的随访,在治疗前、出院后2周、1个月和3个月评估患者的数字评分量表(NRS)和Oswestry功能障碍指数(ODI)评分,以评估治疗效果。
LTEB的平均手术时间为25.7±7.5分钟(15 - 45分钟)。术后5例患者出现下肢无力,但均在24 - 72小时内恢复。接受LTEB治疗的患者术后下腰痛和神经根性疼痛的NRS评分及ODI评分均显著降低(P = 0.001)。术后2周,接受LTEB治疗的患者与对照组相比下腰痛明显缓解(P = 2.224,P = 0.034),两组下腰痛NRS评分的差异随时间推移趋于减小(P = 1.743,P = 0.183)。LTEB治疗使患者的神经根性疼痛明显缓解,ODI评分显著降低(P < 0.001),且LTEB治疗后随着时间推移这种改善变得更加明显(P < 0.01)。
作为一种微创方法,LTEB治疗伴有神经根性疼痛的下腰痛有效,可产生良好的短期疼痛缓解和功能改善效果。