后路硬膜外腔镜检查中类固醇与类固醇加臭氧治疗腰椎间盘突出症的对比：1年随访研究结果

Steroid versus steroid plus ozone during posterior epiduroscopy in the treatment of lumbar herniated disc: results of a 1-year follow-up study.

作者信息

Bayram Derya, Aliyev Dostali, Aşık İbrahim

机构信息

Department of Pain Medicine, Mardin Training and Research Hospital, Mardin, Türkiye.

Department of Anesthesiology and Reanimation, TOBB University of Economics and Technology Faculty of Medicine Hospital, Ankara, Türkiye.

出版信息

BMC Anesthesiol. 2025 Jun 9;25(1):292. doi: 10.1186/s12871-025-03160-5.

DOI:10.1186/s12871-025-03160-5

PMID:40490693

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12147362/

Abstract

BACKGROUND

Ozone has recently been employed in the treatment of low back pain which is a prevalent cause of disability in the population. The objective of this study was to evaluate the effects of the steroids alone or steroids plus ozone during epiduroscopy for chronic low back and radicular lower extremity pain.

METHODS

The files of 76 individuals with chronic lumbar and lower extremity pain who had undergone posterior epiduroscopy were analyzed. One group applied steroids and standard treatment with saline for mechanical disintegration of scarring tissue in the epidural area. Other patients were injected with ozone and steroids in addition to standard treatment. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were performed before and following the intervention, at the 1st, 3rd, 6th, and 12th months. The degree of epidural scar tissue was also recorded during epiduroscopy. The classification of pain as either neuropathic or non-neuropathic was determined by the DN4 (Douleur Neuropathique 4) questionnaire. Results of the Patients Satisfaction Scale were noted in the 12th month. Pre- and post-procedure analgesic use and complications were recorded.

RESULTS

There were 35 and 41 patients in the steroid alone and steroid plus ozone groups, respectively. Patient characteristics were similar, and both treatment groups showed significant differences in mean VAS and ODI scores compared to baseline (p˂0.001). However, the reduction in VAS scores was more significant in the ozone-added patients. The mean disability scores were comparable for the two groups at all follow-up points. Neuropathic pain was present in 42.9% of patients in the steroid-alone group and 34.1% in the combination group and, on follow-up 11 and 25 patients discontinued medication. The findings revealed the presence of moderate to severe fibrous tissue in 94.3% and 80.5% of the patients, respectively. Satisfied/very satisfied with the procedure was reported by 71% of subjects in the steroid-alone group and 92% of subjects in the steroid-plus-ozone group.

CONCLUSION

The combination of epidural ozone with steroids may be a viable option for the management of persistent lumbar and radicular limb pain. For individuals with lumbar herniated discs, this modality has been demonstrated to be both safe and efficacious.

CLINICAL TRIAL NUMBER

Not applicable (Retrospective Study).

摘要

背景

臭氧最近已被用于治疗腰痛，而腰痛是人群中导致残疾的常见原因。本研究的目的是评估在硬膜外腔镜检查治疗慢性腰痛和下肢放射性疼痛时单独使用类固醇或类固醇加臭氧的效果。

方法

分析了76例接受后路硬膜外腔镜检查的慢性腰腿痛患者的病历。一组应用类固醇并采用生理盐水进行标准治疗，以机械分解硬膜外区域的瘢痕组织。其他患者除标准治疗外，还注射了臭氧和类固醇。在干预前、干预后第1、3、6和12个月进行Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评分。在硬膜外腔镜检查期间还记录了硬膜外瘢痕组织的程度。通过DN4（神经病理性疼痛4）问卷确定疼痛是神经性还是非神经性。在第12个月记录患者满意度量表的结果。记录术前和术后的镇痛药物使用情况及并发症。

结果

单独使用类固醇组和类固醇加臭氧组分别有35例和41例患者。患者特征相似，与基线相比，两个治疗组的平均VAS和ODI评分均有显著差异（p˂0.001）。然而，添加臭氧的患者VAS评分降低更为显著。在所有随访点，两组的平均功能障碍评分相当。单独使用类固醇组42.9%的患者存在神经性疼痛，联合组为34.1%，随访时有11例和25例患者停药。结果显示，分别有94.3%和80.5%的患者存在中度至重度纤维组织。单独使用类固醇组71%的受试者和类固醇加臭氧组92%的受试者报告对该手术满意/非常满意。