Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforamina...Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)and in different anatomic levels(Fisher’s exact test p value 0.241).Six out of eight patients with bony recess stenosis benefited as compared to 14 out of 19 patients with PIVD,though it was not statistically significant(Fischer’s exact test p value 0.688).There were no adverse events recorded.Conclusion:TFESI is a safe and efficacious treatment modality in patients with radicular low back pain especially in aged patients in whom surgery under general anaesthesia is not free from risk.展开更多
文摘Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)and in different anatomic levels(Fisher’s exact test p value 0.241).Six out of eight patients with bony recess stenosis benefited as compared to 14 out of 19 patients with PIVD,though it was not statistically significant(Fischer’s exact test p value 0.688).There were no adverse events recorded.Conclusion:TFESI is a safe and efficacious treatment modality in patients with radicular low back pain especially in aged patients in whom surgery under general anaesthesia is not free from risk.
