Chemeisani Ammar, Hamade Ali, Kawtharani Abed AlRaouf, Tarhini Hasan, Hamze Nour, Msheik Ali
Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN.
Internal Medicine, Lebanese University Faculty of Medical Sciences, Hadath, LBN.
Cureus. 2023 Feb 10;15(2):e34847. doi: 10.7759/cureus.34847. eCollection 2023 Feb.
Background Early epidural steroid injections are currently widely used for patients experiencing lumbago. However, there is uncertainty about their efficacy, such as the limitation of continuous drug infusion and the need for well-trained physicians on this technique. The main objective of this study was to evaluate the effectiveness of early epidural steroid injections in treating patients with acute sciatica in the lower back in terms of symptom relief and recurrence rate. Methods A case series was conducted in Lebanon from 2015 to 2019. We recruited 98 patients suffering from sciatica due to disc disease over three-time intervals: two weeks, one, and three months. The immediate results accounted for the intensity of various symptoms (numerical rating scale (NRS) for pain) and the assessment of patient satisfaction (Macnab criteria). Results The clinical results showed at least a three-point pain relief according to Numerical Rating Scale (NRS) and a good grade according to MacNab (P <0.001), with only 10.4% of the total population having a positive leg raise test post-injection. The maximum benefit was noted after two weeks from the injection with a 5.7 mean change in NRS (p<0.001) with a good/excellent response in MacNab and a 4.9 change with only a good response after one month. This study noticed a rebound phenomenon where around half of the patients needed two steroid injections after three months (39.6 % after three months and 17.9 % after six months). Conclusion Even though current guidelines worldwide may suggest the use of conservative treatment for low back pain with acute sciatica, our study has demonstrated the effectiveness of epidural steroid injections in the Lebanese population with a significant outcome.
背景 早期硬膜外类固醇注射目前广泛应用于腰痛患者。然而，其疗效存在不确定性，如持续药物输注的局限性以及对该技术需要训练有素的医生。本研究的主要目的是从症状缓解和复发率方面评估早期硬膜外类固醇注射治疗下背部急性坐骨神经痛患者的有效性。方法 2015年至2019年在黎巴嫩进行了一项病例系列研究。我们在三个时间间隔内招募了98例因椎间盘疾病导致坐骨神经痛的患者：两周、一个月和三个月。即时结果包括各种症状的强度（疼痛数字评定量表（NRS））和患者满意度评估（Macnab标准）。结果 临床结果显示，根据数字评定量表（NRS）疼痛至少缓解三分，根据Macnab标准为良好等级（P<0.001），注射后仅10.4%的患者直腿抬高试验为阳性。注射后两周时获益最大，NRS平均变化5.7（p<0.001），Macnab评定为良好/优秀反应，一个月后变化4.9，仅为良好反应。本研究注意到一种反弹现象，约一半患者在三个月后需要两次类固醇注射（三个月后为39.6%，六个月后为17.9%）。结论 尽管目前全球指南可能建议对伴有急性坐骨神经痛的腰痛采用保守治疗，但我们的研究已证明硬膜外类固醇注射对黎巴嫩人群有效且结果显著。
