129. Epidural Steroid Following Discectomy for Herniated Lumbar Disc Reduces Neurological Impairment and Enhances Recovery: A Randomized Study with Two Year Follow-up

INTRODUCTION: Low-back pain is a common clinical presentation of herniated lumbar disc. The incidence of low back pain is high in our country due to difcult working and living environment. The initial treatment of low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a simple, effective and minimally invasive treatment modality. The aim of this study is to assess the effectiveness of epidural steroid injection for low back and radicular pain. MATERIALS AND METHODS :This is a Prospective observational study. It was carried out on the patients presenting with low back pain due to herniated lumbar disc not responding to conservational management and had Magnetic Resonance Imaging (MRI) proven lumbar disc prolapsed at different level. Injection Methyl prednisolone 80 mg and 2 ml of 0.5% bupivacaine was diluted in 8 ml of normal saline and injected into the affected lumbar epidural space. The functional status of the patient and the severity of pain were evaluated before injection and after injection during the follow-up period by using Ostrewy disability index and visual analogue score. RESULTS: Fifty six patients received the epidural steroid injections, among them three patients did not came for regular follow up till six months and six patients required surgery . remaining forty seven were analyzed , among them 27(55.44%) were male and 20(42.55%) were female. The functional status and pain response of the patients were improved signicantly during all the follow-up periods (p < 0.001). The success rate of this study was 83.92%. No major complications were encountered. CONCLUSION:The ESI is a simple, safe, effective and minimally invasive modality for the management of lumbar radicular pain.

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Epidural Steroid Following Discectomy for Herniated Lumbar Disc Reduces Neurological Impairment and Enhances Recovery

Spine ◽

10.1097/brs.0b013e3181833903 ◽

2008 ◽

Vol 33 (19) ◽

pp. 2028-2033 ◽

Cited By ~ 43

Author(s):

Sten Rasmussen ◽

David Stonor Krum-Møller ◽

Lene Risbro Lauridsen ◽

Søren Erik Holst Jensen ◽

Hans Mandøe ◽

...

Keyword(s):

Lumbar Disc ◽

Neurological Impairment ◽

Herniated Lumbar Disc ◽

Epidural Steroid

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Efficacy of chymopapain chemonucleolysis

Journal of Neurosurgery ◽

10.3171/jns.1985.62.5.0662 ◽

1985 ◽

Vol 62 (5) ◽

pp. 662-666 ◽

Cited By ~ 16

Author(s):

Manucher J. Javid

Keyword(s):

Marked Improvement ◽

Lumbar Disc ◽

Slight Improvement ◽

Content Type ◽

Herniated Lumbar Disc ◽

Fine Print

✓ A 9- to 12-year follow-up review was conducted in 105 of 124 patients who were treated with chymopapain chemonucleolysis for herniated lumbar disc. The data were obtained from responses to a questionnaire. Seventy-nine patients (75.2%) reported marked improvement, six (5.7%) had slight improvement, and 20 (19.0%) had no improvement. Of the 87 patients not receiving workman's compensation, 70 patients (80.5%) had marked improvement; four (4.6%) had slight improvement; and 13 (14.9%) had no improvement. Of the 18 compensation cases, nine patients (50.0%) had marked improvement; two patients (11.1%) had slight improvement; and seven patients (38.9%) had no improvement. These results are comparable to those reported for surgical discectomy, and confirm that chymopapain chemonucleolysis is an alternative to surgery.

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Physical fitness as a predictor of herniated lumbar disc disease – a 33-year follow-up in the Copenhagen male study

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-14-86 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 7

Author(s):

Marie B Jørgensen ◽

Andreas Holtermann ◽

Finn Gyntelberg ◽

Poul Suadicani

Keyword(s):

Physical Fitness ◽

Lumbar Disc ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Herniated Lumbar Disc

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Occupational and Other Predictors of Herniated Lumbar Disc Disease—A 33-Year Follow-up in The Copenhagen Male Study

Spine ◽

10.1097/brs.0b013e3181f9b8d4 ◽

2011 ◽

Vol 36 (19) ◽

pp. 1541-1546 ◽

Cited By ~ 22

Author(s):

Inge Gregersen Sørensen ◽

Peter Jacobsen ◽

Finn Gyntelberg ◽

Poul Suadicani

Keyword(s):

Lumbar Disc ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Herniated Lumbar Disc

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Syndrome of the incidental herniated lumbar disc

Journal of Neurosurgery ◽

10.3171/jns.1983.59.1.0137 ◽

1983 ◽

Vol 59 (1) ◽

pp. 137-141 ◽

Cited By ~ 15

Author(s):

James E. Wilberger ◽

Dachling Pang

Keyword(s):

Clinical Features ◽

Lumbar Disc Herniation ◽

Lumbar Disc ◽

Herniated Disc ◽

Content Type ◽

Asymptomatic Patients ◽

Appropriate Treatment ◽

Herniated Lumbar Disc ◽

Fine Print

✓ Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.

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Follow-up of at least five years after lumbar transforaminal epidural steroid injection for radicular pain due to lumbar disc herniation

Annals of Palliative Medicine ◽

10.21037/apm.2020.01.05 ◽

2020 ◽

Vol 9 (1) ◽

pp. 116-118 ◽

Cited By ~ 2

Author(s):

Seung Hwa Jang ◽

Min Cheol Chang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Steroid Injection ◽

Lumbar Disc ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

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Nucleoplasty with NuCore Injectable Nucleus Replacement for Herniated Lumbar Disc: A Multicenter Study with a Minimum Five-Year Follow-up

Journal of Spine & Neurosurgery ◽

10.4172/2325-9701.1000214 ◽

2016 ◽

Vol 05 (02) ◽

Author(s):

Berlemann U ◽

Schwarzenbach O

Keyword(s):

Multicenter Study ◽

Lumbar Disc ◽

Herniated Lumbar Disc

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Microdiscectomy Improves Pain-Associated Depression, Somatic Anxiety, and Mental Well-Being in Patients With Herniated Lumbar Disc

Neurosurgery ◽

10.1227/neu.0b013e3182302ec3. ◽

2011 ◽

Vol 70 (2) ◽

pp. 306-311 ◽

Cited By ~ 18

Author(s):

Richard Lebow ◽

Scott L. Parker ◽

Owoicho Adogwa ◽

Adam Reig ◽

Joseph Cheng ◽

...

Keyword(s):

Lumbar Disc ◽

Well Being ◽

Leg Pain ◽

Low Back ◽

Analog Scale ◽

Somatic Anxiety ◽

Sf 36 ◽

Herniated Lumbar Disc ◽

Mental Well Being

Abstract BACKGROUND: Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood. OBJECTIVE: To assess the effect of microdiscectomy on depression, somatization, and mental well-being in patients with herniated lumbar discs. METHODS: Patients undergoing surgical discectomy for single-level, herniated lumbar disc were prospectively evaluated preoperatively, and at 6 weeks and 3, 6, and 12 months postoperatively. Back and leg pain, depression, somatic perception, and mental well-being were assessed. RESULTS: One hundred patients were enrolled. All were available for 1-year follow-up. Preoperatively, the visual analog scale for low-back pain (BP-VAS), visual analog scale for leg pain (LP-VAS), Zung Self-Rating Depression Scale (ZUNG), Modified Somatic Perception Questionnaire (MSPQ), and Medical Outcomes Short Form-36 mental component summary scale (SF-36-MCS) were 6.3 ± 2.5, 6.3 ± 2.5, 19 ± 11, 9 ± 7, and 4 ± 14. BP-VAS and LP-VAS significantly improved by 6 weeks. Significant improvement in SF-36-MCS was observed by 6 weeks postoperatively, improvement in MSPQ score was observed 3 months postoperatively, and improvement in the ZUNG depression score was observed 12 months postoperatively. No statistical difference occurred during the remainder of follow-up for any outcome measured once improvement reached statistical significance. Eighteen patients were somatized preoperatively, 67% of which were nonsomatized 1 year postoperatively. Ten patients were clinically depressed preoperatively, 70% of which were nondepressed 1 year postoperatively. Improvement in SF-36-MCS, ZUNG, and MSPQ correlated (P < .001) with improvement in BP-VAS and LP-VAS. CONCLUSION: The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.

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Study on the functional outcome of fluoroscopically guided transforaminal epidural steroid injections in patients suffering from lumbar disc herniation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171910 ◽

2017 ◽

Vol 3 (3) ◽

pp. 607

Author(s):

S. Natarajan ◽

Anjan Venkataraman Krishnamurthy ◽

R. Kalanithi ◽

M. D. Ilavarasan

Keyword(s):

Functional Outcome ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Short Term ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Vas Score ◽

Epidural Steroid

Background: Intervertebral disc herniation of the lumbar region is one of the common causes of acute low back ache and lower extremity pain. While multiple treatment modalities exist, the efficacy of the usage of a transforaminal steroid injection as a tool to either alleviate pain or delay surgery needs to be further evaluated. The aim of this study is to determine the functional outcome of patients suffering from lumbar disc herniation treated with fluroscopically-guided transforaminal epidural steroid injections.Methods: This is a prospective case study in which total of 43 patients were included in the study dating between August 2014 and July 2015. These patients were evaluated and identified with lumbar disc herniation, confirmed with a magnetic resonance imaging prior to the procedure. A pre-injection VAS score was taken. These patients were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. They were then evaluated during follow up at 2 weeks, 6 weeks, 12 weeks, and 6 months. Their pain outcome was evaluated using the VAS (visual analog scale) scores and functional outcome was evaluated using Oswestry disability index (ODI).Results: All patients showed significant improvement in the VAS score during their regular follow up when compared to their pre injection levels. Patient satisfaction was the high at 2 weeks post operatively slightly declining over time. 3 patients underwent surgery during the follow up period. The ODI scores also showed significant improvements when compared to the pre injection scores at all follow up periodsConclusions: TFESI provides significant short-term pain relief in patients suffering from a single level lumbar herniated disc and is a viable, effective short-term analgesic tool to address pain and may retard an early surgical intervention.

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