Department of Neurology, Ziv Medical Center, Safed, Israel.
Faculty of Medicine, Bar-Ilan University, Israel.
Medicine (Baltimore). 2022 Jul 15;101(28):e29272. doi: 10.1097/MD.0000000000029272.
Retrospective study. The purpose of this study was to investigate the clinical symptomatology of discopathies before and 7 days after treatment with one of the following: intravenous dexamethasone, selective nerve root block (SNRB), and systemic treatment with different nonsteroidal antiinflammatory drugs (NSAIDs). Radiculopathy is a clinical condition in which dysfunction of one or more nerves occurs due to mechanical compression and/or chemical irritation of the nerve roots. Most often located in the lumbar spine, radiculopathy remains one of the most common complaints in primary health. Some patients responded well to conservative treatment. However, those who show no improvement may benefit from more invasive treatment options, such as intravenous corticosteroids, spinal injections, and surgical procedures. We conducted a retrospective study of 81 male and female patients aged 18 years and above who had radicular pain and were referred to our facility over a 7-year period. Of the 100 patients assessed for eligibility, 19 patients were not included in the study due to malignancy or surgical intervention, 32 patients received intravenous dexamethasone, 24 patients received SNRB, and 25 received various NSAIDs as the control group. The visual analog scale, straight leg raise test and neurological deficits were assessed to evaluate the patients before and after receiving treatment. All patients underwent spinal computed tomography to confirm the diagnosis of disc herniation. Pearson chi-squared test, Kruskal-Wallis test, and Mann-Whitney test were used to evaluate the results. Visual analog scale scores and the ability to perform straight leg raise test significantly improved after treatment with dexamethasone, SNRB, and NSAIDs. However, clinical improvement was significantly better in both the dexamethasone and SNRB groups than in the control group. Motor deficits improved significantly after dexamethasone treatment alone. Dexamethasone and SNRB are useful and safe treatment options for treating patients with acute radicular pain. Randomized, double-blinded, control studies are warranted.
回顾性研究。本研究旨在探讨在以下治疗方法之一治疗前后的椎间盘病变的临床症状：静脉内地塞米松、选择性神经根阻滞（SNRB）和全身使用不同的非甾体抗炎药（NSAIDs）。根性神经病是一种由于神经根的机械压迫和/或化学刺激而导致一个或多个神经功能障碍的临床状况。最常位于腰椎，根性神经病仍然是初级保健中最常见的抱怨之一。一些患者对保守治疗反应良好。然而，那些没有改善的患者可能受益于更具侵入性的治疗选择，如静脉内皮质类固醇、脊柱注射和手术程序。我们对 81 名年龄在 18 岁及以上、有神经根痛并在 7 年内被转诊到我们医院的男性和女性患者进行了回顾性研究。在评估合格性的 100 名患者中，由于恶性肿瘤或手术干预，19 名患者未被纳入研究，32 名患者接受了静脉内地塞米松治疗，24 名患者接受了选择性神经根阻滞治疗，25 名患者作为对照组接受了各种 NSAIDs 治疗。使用视觉模拟量表、直腿抬高试验和神经功能缺损评估来评估治疗前后的患者。所有患者均行脊柱计算机断层扫描以确认椎间盘突出症的诊断。使用 Pearson 卡方检验、Kruskal-Wallis 检验和 Mann-Whitney 检验评估结果。地塞米松、SNRB 和 NSAIDs 治疗后，视觉模拟量表评分和直腿抬高试验能力显著改善。然而，地塞米松和 SNRB 组的临床改善明显优于对照组。单独用地塞米松治疗后运动功能缺损显著改善。地塞米松和 SNRB 是治疗急性根性疼痛患者的有用且安全的治疗选择。需要进行随机、双盲、对照研究。
