Güven Köse Selin, Köse Halil Cihan, Çelikel Feyza, Akkaya Ömer Taylan
Department of Pain Medicine, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey.
Department of Physical Therapy and Rehabilitation, Sakarya Training and Research Hospital, Sakarya, Turkey.
Eurasian J Med. 2023 Feb;55(1):43-49. doi: 10.5152/eurasianjmed.2023.22265.
The aim of this prospective randomized controlled study was to compare the effectiveness and accuracy of the ultrasound- and fluoroscopy-guided S1 transforaminal epidural injection combined with pulsed radiofrequency in patients with lumbosacral radicular pain caused by S1 nerve involvement.
A total of 60 patients were randomized into 2 groups. Patients received S1 transforaminal epidural injection combined with pulsed radiofrequency under either ultrasound or fluoroscopy guidance. Primary outcomes were estimated with Visual Analog Scale scores at 6 months. Secondary outcomes included Oswestry Disability Index, Quantitative Analgesic Questionnaire, and patient satisfaction scores during the 6-month follow-up period and procedure-related variables including procedure time and accuracy of the needle replacement.
Both techniques provided significant pain reduction and functional improvement for 6 months compared to baseline (P < .001), without statistical significance between groups at each follow-up point. There was no significant difference in pain medication consumption (P=.441) and patient satisfaction scores (P=.673) between groups. The fluoroscopy guidance for combined transforaminal epidural injection with pulsed radiofrequency at S1 provided a greater accuracy for the cannula replacement (100%) than the ultrasound (93.3%), without significant difference between groups (P=.491).
The ultrasound-guided combined transforaminal epidural injection with pulsed radiofrequency at S1 level is a feasible alternative to fluoroscopy guidance. In this study, we reported that the ultrasoundguided technique resulted in similar treatment benefits including improvement in pain intensity and functionality and reduction in pain medication consumption as those in the fluoroscopy group, while reducing the risk for radiation exposure.
本前瞻性随机对照研究旨在比较超声引导和透视引导下S1经椎间孔硬膜外注射联合脉冲射频治疗S1神经受累所致腰骶神经根性疼痛患者的有效性和准确性。
共60例患者随机分为2组。患者在超声或透视引导下接受S1经椎间孔硬膜外注射联合脉冲射频治疗。主要结局指标采用6个月时的视觉模拟量表评分进行评估。次要结局指标包括6个月随访期内的Oswestry功能障碍指数、定量镇痛问卷和患者满意度评分，以及与操作相关的变量，包括操作时间和穿刺针置换的准确性。
与基线相比，两种技术在6个月时均能显著减轻疼痛并改善功能（P < .001），各随访点组间无统计学差异。两组间的止痛药物消耗量（P = .441）和患者满意度评分（P = .673）无显著差异。S1经椎间孔硬膜外注射联合脉冲射频的透视引导下套管置换的准确性（100%）高于超声引导（93.3%），组间无显著差异（P = .491）。
超声引导下S1水平经椎间孔硬膜外注射联合脉冲射频是透视引导的一种可行替代方法。在本研究中，我们报告超声引导技术产生了与透视组相似的治疗效果，包括疼痛强度和功能的改善以及止痛药物消耗量的减少，同时降低了辐射暴露风险。
