Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches
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Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.
Abstract
Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.
참고문헌 (16)
- Mehta M, "Extradural block. Confirmation of the injection site by X-ray monitoring", Anaesthesia, 40, pp.1009~1012 (1985)
- Botwin KP, "Fluoroscopic guided lumbar interlaminar epidural injections : a prospective evaluation of epidurography contrast patterns and anatomical review of the epidural space", Pain Physician, 7, pp.77~80 (2004)
- McLain RF, "Epidural steroid therapy for back and leg pain : mechanisms of action and efficacy", Spine J, 5, pp.191~201 (2005)
- Candido KD, "A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections : the lateral parasagittal interlaminar epidural approach versus the transforaminal epidural approach", Anesth Analg, 106, pp.638~644 (2008)
- Rosenberg SK, "Effectiveness of transforaminal epidural steroid injections in low back pain: a one year experience", Pain Physician, 5, pp.266~270 (2002)
- Vad VB, "Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study", Spine (Phila Pa 1976), 27, pp.11~16 (2002)
- Buenaventura RM, "Systematic review of therapeutic lumbar transforaminal epidural steroid injections", Pain Physician, 12, pp.233~251 (2009)
- Furman MB, "Contrast flow selectivity during transforaminal lumbosacral epidural steroid injections", Pain Physician, 11, pp.855~861 (2008)
- Rados I, "Efficacy of interlaminar vs transforaminal epidural steroid injection for the treatment of chronic unilateral radicular pain: prospective, randomized study", Pain Med, 12, pp.1316~1321 (2011)
- Lutz GE, "Fluoroscopic transforaminal lumbar epidural steroids : an outcome study", Arch Phys Med Rehabil, 79, pp.1362~1366 (1998)
- Smith CC, "Interlaminar versus transforaminal epidural steroid injections for the treatment of symptomatic lumbar spinal stenosis", Pain Med, 11, pp.1511~1515 (2010)
- Botwin K, "Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections : a prospective evaluation", Pain Physician, 7, pp.211~215 (2004)
- Choi YK, "Evaluation of epidurographic contrast patterns with fluoroscopic-guided lumbar interlaminar ventral epidural injection", Pain Pract, 9, pp.275~281 (2009)
- Manchikanti L, "Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report", Pain Physician, 7, pp.217~223 (2004)
- Desai MJ, "Epidural contrast flow patterns of transforaminal epidural steroid injections stratified by commonly used final needle-tip position", Pain Med, 12, pp.864~870 (2011)
- Yang SC, "Transforaminal epidural steroid injection for discectomy candidates: an outcome study with a minimum of two-year follow-up", Chang Gung Med J, 29, pp.93~99 (2006)