Kim Hee Jung, Nam Ho Jae, Kim Shin Hyung
Department of Anesthesiology and Pain Medicine Anesthesia and Pain Research Institute Yonsei University College of Medicine, Seoul, Republic of Korea.
Pain Res Manag. 2024 Sep 7;2024:5038496. doi: 10.1155/2024/5038496. eCollection 2024.
The global increase in the elderly population has led to a higher prevalence of degenerative lumbar spinal diseases. Epidural steroid injection (ESI) is a widely used procedure for managing lower back pain. This study investigated the association of preprocedural frailty status with the efficacy of ESI in elderly patients diagnosed with degenerative lumbar spinal diseases. This retrospective observational study included patients aged 65 years and older who underwent lumbar ESI. Frailty status (robust, prefrail, and frail) assessed via the Frailty Phenotype Questionnaire was collected along with demographic and clinical parameters. Good analgesia was defined as a ≥ 50% reduction in pain score at 4-week follow-up evaluation. Multivariable logistic regression analyses were performed to identify factors associated with poor analgesia. We included 289 patients in this study. Frailty status correlated with analgesic outcomes, with worsening frailty status correlating with increasingly poor analgesia after the injection (robust = 34.5%, prefrail = 40.8%, and frail = 60.0%, =0.003), predominantly in female patients. After adjusting for demographic and clinical factors, frail patients demonstrated much higher odds of poor analgesia than robust individuals (adjusted odds ratio [aOR] = 2.673, 95% confidence interval [CI] = 1.338-5.342, =0.005). Conversely, prefrail patients did not show a significant association with analgesic outcome (aOR = 1.293, 95% CI = 0.736-2.272, =0.372). Frailty, but not prefrailty, appeared to be an independent factor associated with poor analgesic efficacy of ESI in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care.
全球老年人口的增加导致退行性腰椎疾病的患病率更高。硬膜外类固醇注射（ESI）是一种广泛用于治疗下背痛的方法。本研究调查了术前虚弱状态与ESI对诊断为退行性腰椎疾病的老年患者疗效之间的关联。这项回顾性观察研究纳入了65岁及以上接受腰椎ESI的患者。通过衰弱表型问卷评估的虚弱状态（强健、衰弱前期和衰弱）以及人口统计学和临床参数均被收集。良好镇痛定义为在4周随访评估时疼痛评分降低≥50%。进行多变量逻辑回归分析以确定与镇痛效果不佳相关的因素。本研究纳入了289例患者。虚弱状态与镇痛结果相关，注射后虚弱状态恶化与镇痛效果越来越差相关（强健=34.5%，衰弱前期=40.8%，衰弱=60.0%，P=0.003），主要在女性患者中。在调整人口统计学和临床因素后，衰弱患者镇痛效果不佳的几率比强健个体高得多（调整后的优势比[aOR]=2.673，95%置信区间[CI]=1.338 - 5.342，P=0.005）。相反，衰弱前期患者与镇痛结果无显著关联（aOR=1.293，95%CI=0.736 - 2.272，P=0.372）。在接受保守治疗的有症状退行性腰椎疾病老年患者中，衰弱而非衰弱前期似乎是与ESI镇痛效果不佳相关的独立因素。
