Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea.
Medicina (Kaunas). 2024 May 15;60(5):809. doi: 10.3390/medicina60050809.
: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. : A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. : In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups ( < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. : When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.
本研究旨在评估超声（US）和透视（FL）联合引导与 US 引导和 FL 引导下骶尾部硬膜外类固醇注射（CESI）治疗单侧下腰椎根性疼痛的中期疗效和安全性。
共纳入 2018 年至 2022 年间接受 CESI 的 154 例患者。根据引导方法将患者分为三组：联合 US 和 FL（n=51）、US 引导（n=51）和 FL 引导（n=52）。研究设计为回顾性病例对照研究，使用患者图表和标准化表格评估临床结果、不良事件和操作过程中的并发症。
在所有组中，Oswestry 残疾指数和数字评分量表（Numeric Scale）评分在末次注射后 1、3 和 6 个月均有改善，组间无显著差异（<0.05）。所有时间点的治疗成功率在组间也相似。Logistic 回归分析显示，注射方法、病因、性别、年龄、注射次数和疼痛持续时间均不能独立预测治疗成功。在联合 US 和 FL 组、FL 引导组和 US 引导组中，分别有 2%（n=1）、13.5%（n=7）和 4%（n=2）的患者在注射前抽吸血液。在联合方法组中有 1 例患者和在 FL 引导组中有 7 例患者发现血管内对比剂扩散。
在比较疼痛减轻和功能改善方面，三种方法之间无显著差异。与单独使用 FL 相比，联合方法所需时间更短。与单独使用 FL 相比，联合方法的血管内注射发生率也较低。此外，联合方法可以使用超声识别注射部位的血管。鉴于这些优势，对于单侧腰椎根性疼痛患者，在进行 CESI 时，优先考虑联合 US 和 FL 引导治疗可能是明智的。
