scholarly journals EPIDURAL STEROID INJECTION IN HERNIATED DISC AND LUMBAR CANAL STENOSIS: IS IT JUST A PLACEBO?

2021 ◽  
Vol 20 (3) ◽  
pp. 189-191
Author(s):  
AJAY KUMAR SHETTY PAPANNA ◽  
SUJITH RAO VITTALDAS ◽  
BALAMURUGAN THIRUGNANAM ◽  
VIDYADHARA SRINIVASA

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.

2019 ◽  
Vol 44 (5) ◽  
pp. 586-594 ◽  
Author(s):  
Steven P Cohen ◽  
Tina L Doshi ◽  
Timothy C Dawson ◽  
Anita Gupta ◽  
Shravani Durbhakula ◽  
...  

BackgroundStudies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes.MethodsHR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure.ResultsThe mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and −0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007).ConclusionsNon-immune-related HR were inversely correlated with some ESI outcome measures.


Author(s):  
Jayakrishnan Rajasekharan

<p class="abstract"><strong>Background:</strong> 85 patients of different age groups were treated with caudal epidural steroid injection for the management of low back pain. As low back pain is quite common in adults.</p><p class="abstract"><strong>Methods:</strong> X-ray, MRI of the lumbar region was studied. Degree of the pain was assessed by VAS (visual analogue scale) scale, study of Lumbo-sacral joint was studied to know the causes of low back pain (LBP).<strong></strong></p><p class="abstract"><strong>Results:</strong> As per the MRI study classification LBP was classified as, 16 (16.3%) had Acute back pain without any cause, 14 (14.2%) had spondylolithesis having symptoms of claudication with low back pain. 26 (26.5%) had stenosis of Lumbar canal with symptoms of claudication 42 (42.8%) had disc degeneration with or without root radiation having complaint of back pain and leg pain. The improvement as per VAS scale was from 1 week to 3 months in the management of LBP.</p><p align="center"><strong>Conclusions:</strong> This pragmatic approach to various causes of low back pain managed with epidural steroid injection will be useful to orthopedic surgeon to treat such pain efficiently because back pain becomes common factor as age advances due to resorption or degenerative factors andcurvatures of vertebral column becomes less pronounceds. </p>


2014 ◽  
Vol 26 (1) ◽  
pp. 09-11
Author(s):  
Md Mahmudur Rahman ◽  
Md Imamur Rashid ◽  
Nadia Rahman ◽  
MA Shakoor

Pain in the back is the most common of all chronic pain disorders. Back pain and sciatica, or leg pain originating from injury to or pressure on the sciatic nerve, are major causes of disability in adults, occurring in 15% to 20% of the working-age population annually and 70% to 90% of adults at some point in their lives. Men and women are affected equally. The study was conducted prospectively in 60 patients of 18 to 60 years of age with documented chronic low back pain with sciatica. Thirty patients were treated in group-A with conservative treatment (NSAID+ therapeutic exercises+ superficial thermotherapy and ADL instruction) plus epidural steroid injection and 30 samples were treated in group B with conservative treatment only. Epidural steroid injection treatment group is significantly improved than conservative treatment group (p<0.05). There was more improvement of pain in group –A than in Group B ( p= 0.007) and SLR was more increased in group –A than group-B (p=0.03). So, epidural steroid injection is a effective treatment for lumber rediculopathy especially in acute phase. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21302 Medicine Today 2014 Vol.26(1): 09-11


2021 ◽  
Vol 71 (4) ◽  
pp. 1368-71
Author(s):  
Moazzam Ali ◽  
Rashid Iqbal ◽  
Majid Waseem ◽  
Liaquat Ali ◽  
Tahseen Talib ◽  
...  

Objective: To determine the efficacy of transforaminal epidural steroid injection (TFESI) using conventional versus Kambin’s triangle approaches in patients of lumbar radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Pain Medicine, Combined Military Hospital Rawalpindi Pakistan, from Oct 2019 to Apr 2020. Methodology: Eighty patients suffering from lumbar radiculopathy fulfilling the inclusion criteria were included in this study and were randomly assigned to undergo transforaminal epidural steroid injection using either conventional approach (group C) or the Kambin’s triangle (group K) approach. Pain scores and patient satisfaction levels were recorded at 4 and 8 weeks after the procedure. Results: In both groups, the pain score (group C pre-procedure NRS =7.28 ± 1.26 vs post-procedure NRS = 2.14 ± 0.81, group K pre-procedure NRS = 7.33 ± 1.16 vs post-procedure NRS=2.70 ± 0.94) and patient satisfaction improved 4 and 8 weeks after the procedure. The pain score (p-value=0.21) and patient satisfaction score (p-value=0.88) however were not significantly different between groups. Conclusion: This study demonstrated that using conventional or Kambin’s approach exhibits no difference in decreasing pain score or patient satisfaction level.


2021 ◽  
pp. 52-54
Author(s):  
Ravi Ranjan Singh ◽  
Bharat Singh

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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