Department of Pain Medicine, Health Sciences University Gulhane Training and Research Hospital, Ankara, Turkey.
Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Pain Physician. 2022 Mar;25(2):161-169.
Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches.
To investigate the efficacy of caudal epidural steroid injection (CESI) versus transforaminal epidural steroid injection (TFESI) in patients with PLSS.
A prospective, randomized, assessor-blind study.
Interventional pain management center at a tertiary care center.
Patients with low back and radicular pain related to EF following single-level lumbar discectomy were included. The patients were randomly divided into 2 groups: a CESI group and a TFESI group. All patients were assessed before the procedure (baseline) and at one hour, 3 weeks, and 3 months after the procedure using the Numeric Rating Scale (NRS-11) and at baseline, 3 weeks, and 3 months using the modified Oswestry Disability Index (mODI). Treatment success was defined as a >= 50% decrease in the NRS-11 scores compared to baseline.
A total of 56 patients (n = 26 CESI group; n = 30 TFESI group) were included. NRS-11 and mODI scores showed a significant decline in both groups at all follow-ups (P < 0.001). At 3 weeks, the improvement in the mODI scores was significantly higher in the TFESI group (P = 0.020). In all follow-ups, the NRS-11 scores were similar between the groups. At 3 weeks, the rates of patients with a >= 50% decrease in NRS-11 scores were 53.8% and 60% in the CESI group and TFESI group, respectively, while these rates were 30% and 26.7%, respectively, at 3 months.
This study had no placebo-control group and a relatively short follow-up.
Both CESI and TFESI are effective and safe methods in the treatment of PLSS caused by EF following lumbar discectomy. These methods can reduce pain and disability. Although both methods have similar treatment success rates, TFESI seems to be a more effective treatment method in reducing disability at 3-week follow-up.
硬膜外纤维化（EF）是腰椎手术后综合征（PLSS）的主要原因之一。尽管文献中有研究表明腰椎硬膜外类固醇注射是治疗 EF 引起的 PLSS 的有效方法，但尚无研究比较骶管和经椎间孔硬膜外类固醇注射的有效性和安全性。
探讨骶管硬膜外类固醇注射（CESI）与经椎间孔硬膜外类固醇注射（TFESI）治疗 PLSS 的疗效。
前瞻性、随机、评估者盲法研究。
三级医疗中心的介入性疼痛管理中心。
纳入接受单节段腰椎间盘切除术治疗后出现与 EF 相关的下腰痛和神经根痛的患者。患者随机分为 2 组：CESI 组和 TFESI 组。所有患者在术前（基线）和术后 1 小时、3 周和 3 个月时使用数字评分量表（NRS-11）进行评估，并在基线、3 周和 3 个月时使用改良 Oswestry 残疾指数（mODI）进行评估。治疗成功定义为与基线相比，NRS-11 评分下降>=50%。
共纳入 56 例患者（n=26 CESI 组；n=30 TFESI 组）。两组在所有随访中 NRS-11 和 mODI 评分均显著下降（P<0.001）。在 3 周时，TFESI 组 mODI 评分的改善明显更高（P=0.020）。在所有随访中，两组的 NRS-11 评分相似。在 3 周时，CESI 组和 TFESI 组 NRS-11 评分下降>=50%的患者比例分别为 53.8%和 60%，而 3 个月时分别为 30%和 26.7%。
本研究没有安慰剂对照组，随访时间相对较短。
CESI 和 TFESI 都是腰椎间盘切除术后 EF 引起的 PLSS 的有效且安全的治疗方法。这些方法可以减轻疼痛和残疾。虽然两种方法的治疗成功率相似，但 TFESI 在 3 周随访时似乎是一种更有效的治疗方法，可以降低残疾程度。
