Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients

2021 ◽  
pp. 1-5
Author(s):  
Bahar Dernek ◽  
Suavi Aydoğmuş ◽  
İbrahim Ulusoy ◽  
Tahir Mutlu Duymuş ◽  
Sedef Ersoy ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Low Back Pain ◽  
Lumbar Disc ◽  
Lower Limbs ◽  
Low Back ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Caudal Epidural

BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4–L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Non-surgical management of lumbar disc disease

1977 ◽  
Vol 15 (25) ◽  
pp. 98-99
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Metabolic Bone Disease ◽  
Lumbar Disc ◽  
Uterine Disease ◽  
Low Back ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Metabolic Bone ◽  
Objective Evidence

Persistent low back pain is often ascribed to lumbar disc disease. Frequently no objective evidence supports this and the management is designed solely to alleviate symptoms. Inflammatory arthritis, metabolic bone disease, ligamentous injuries, metastases, infections, uterine disease, retroperitoneal lesions involving the lumbo-sacral plexus, renal disease, intraspinal lesions and depression may also cause low back pain and should be considered in the management of the patient. Occasionally appropriate special investigations are necessary. Lumbar disc lesions may cause acute, sub-acute or chronic symptoms and the management differs accordingly.

Preliminary Results of a Randomized, Equivalence Trial of Fluoroscopic Caudal Epidural Injections in Managing Chronic Low Back Pain: Part 3 – Post Surgery Syndrome

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 817-831
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Lumbar Surgery ◽  
Epidural Injections ◽  
Post Surgery ◽  
Significant Pain ◽  
Caudal Epidural

Background: Post surgery syndrome resulting in persistent pain following lumbar spine surgery is common. Speculated causes of post lumbar surgery syndrome include stenosis, degeneration of adjacent segments, internal disc disruption, recurrent disc herniation, retained disc fragment, epidural or intraneural fibrosis, radiculopathy, and various other causes. Epidural injections are most commonly used in post surgery syndrome. There is lack of evidence for the effectiveness of epidural injections in managing chronic low back pain with or without lower extremity pain secondary to post surgery syndrome. Study Design: A randomized, double-blind, equivalence trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objectives: To evaluate the effectiveness of caudal epidural injections in patients with chronic low back and lower extremity pain after surgical intervention with post lumbar surgery syndrome. Methods: Patients were randomly assigned to one of 2 groups; Group I patients received caudal epidural injections with local anesthetic (lidocaine 0.5%), whereas Group II patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of 6 mg non-particulate Celestone. Randomization was performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized which included the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3 months, 6 months, and 12 months post-treatment. Significant pain relief was described as 50% or more, whereas significant improvement in the disability score was defined as a reduction of 40% or more. Results: Significant pain relief (≥ 50%) was recorded in 60% to 70% of the patients with no significant differences noted with or without steroid over a period of one-year. In addition, functional assessment measured by the ODI also showed significant improvement with at least 40% reduction in Oswestry scores in 40% to 55% of the patients. The average procedures per year were 3.4 with an average total relief per year of 31.7 ± 19.10 weeks in Group I and 26.2 ± 18.34 weeks in Group II over a period of 52 weeks. Limitations: The results of this study are limited by the lack of a placebo group and the preliminary report size of only 20 patients in each group. Conclusion: Caudal epidural injections in chronic function-limiting low back pain in post surgery syndrome without facet joint pain demonstrated effectiveness with over 55% of the patients showing improvement in functional status with significant pain relief in 60% to 70%. Key words: Post lumbar surgery syndrome, post lumbar laminectomy syndrome, chronic low back pain, epidural adhesions, epidural steroid injections, epidural fibrosis, recurrent disc herniation, spinal stenosis

scholarly journals Preliminary Results of a Randomized, Equivalence Trial of Fluoroscopic Caudal Epidural Injections in Managing Chronic Low Back Pain: Part 4 — Spinal Stenosis

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 833-848
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Epidural Injections ◽  
Group I ◽  
Caudal Epidural

Background: Spinal stenosis is one of the 3 most common diagnoses of low back and leg symptoms which also include disc herniation and degenerative spondylolisthesis. Spinal stenosis is a narrowing of the spinal canal with encroachment on the neural structures by surrounding the bone and soft tissue. In the United States, one of the most commonly performed interventions for managing chronic low back pain are epidural injections, including their use for spinal stenosis. However, there have not been any randomized trials and evidence is limited with regards to the effectiveness of epidural injections in managing chronic function-limiting low back and lower extremity pain secondary to lumbar spinal stenosis. Study Design: A randomized, double-blind, equivalence trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objectives: To evaluate the effectiveness of caudal epidural injections with or without steroids in providing effective and long-lasting pain relief in the management of chronic low back pain in spinal stenosis and to evaluate the differences between local anesthetic with or without steroids. Methods: Patients were randomly assigned to one of 2 groups, with Group I patients receiving caudal epidural injections of local anesthetic (lidocaine 0.5%), whereas Group II patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid. Randomization is being performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized which included the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3 months, 6 months, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as reduction of 40% or more. Results: Significant pain relief (≥ 50%) was demonstrated in 55% to 65% of the patients and functional status improvement with 40% reduction in ODI scores in 55% to 80% of the patients. The overall average procedures per year were 3.4 ± 1.27 in Group I and 2.6 ± 1.35 in Group II with an average total relief per year of 30.3 ± 19.49 weeks in Group I and 23.1 ± 21.36 weeks in Group II over a period of 52 weeks. Limitations: The results of this study are limited by the lack of a placebo group and a preliminary report of 20 patients in each group, even though sample was justified. Conclusion: Caudal epidural injections with or without steroids may be effective in patients with chronic function-limiting low back and lower extremity pain with spinal stenosis in approximately 60% of the patients. Key words: Low back pain, lower extremity pain, spinal stenosis, epidural injections, steroids, local anesthetics

scholarly journals Viable Disc Tissue Allograft Supplementation; One- and Two-level Treatment of Degenerated Intervertebral Discs in Patients with Chronic Discogenic Low Back Pain: One Year Results of the VAST Randomized Controlled Trial

2021 ◽  
Vol 24 (6) ◽  
pp. 465-477
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Saline Group ◽  
Low Back ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Disc Tissue ◽  
Tissue Allograft ◽  
One Year

Background: A viable disc tissue allograft has been developed to supplement tissue loss associated with degenerative lumbar disc disease and the development of chronic discogenic lower back pain. Objectives: Viable disc allograft was injected into painful degenerated discs to evaluate safety and determine whether it can improve pain and function. Study Design: Patients received an active treatment of allograft or saline, or continued with nonsurgical management (NSM). Prior to entering the study, patients had back pain for a minimum of 6 months before treatment that was recalcitrant to nonoperative treatment modalities. Standardized outcome measures were used to evaluate the patient’s condition before and after treatment. Primary endpoints included improvement in Oswestry Disability Index (ODI) and Visual Analog Scale of Pain Intensity (VASPI). Conventional radiographs and magnetic resonance imaging scans were used to assess disc space height and spinal alignment, and to determine the degree of disc degeneration. Patients were followed for one year after enrollment. The NSM group could cross over to the allograft group after 3 months. Setting: This multicenter trial was completed in outpatient surgical centers and office injection suites. A total of 218 patients with chronic low back pain secondary to single-level or 2-level degenerative disc disease were enrolled. Inclusion criteria included pretreatment VASPI >= 40 mm, ODI score >= 40 and symptoms present longer than 6 months. Patients were blinded and randomized to receive intradiscal injections of either viable disc allograft or saline. Patients randomized to the NSM group continued existing treatment. Patients were assessed at 6 and 12 months. Adverse events (AEs) were continually assessed. Methods: The VAST trial is a prospective, multicenter, blind, randomized clinical trial (RCT) for patients with single-level or 2-level degenerative lumbar disc disease. Results: At 12 months, clinically meaningful improvements in mean VASPI and ODI scores were achieved in the investigational allograft and saline groups. A responder analysis demonstrated a clinically meaningful reduction in ODI of >= 15 points at 12 months that was statistically significant; 76.5% of patients randomized to allograft were responders (P = 0.03) compared to 56.7% in the saline group. A responder group characterized by a ? 20 point reduction in pain at 12 months achieved a statistically significant reduction in pain compared to the saline group (P = 0.022). In the allograft group, 11 safety adverse events occurred in 141 patients (3.5%) and there were no persistently symptomatic AEs. Limitations: Limitations of this study include a comparison to saline that has been shown to be more representative of an active comparator as opposed to a placebo. In addition, 36 patients were lost to follow-up; this loss resulted in the saline and NSM/crossover groups being smaller than the predetermined group size to have an appropriately powered analysis. Conclusions: This large, prospective blinded RCT demonstrated safety and efficacy results indicating that viable disc tissue allograft may be a beneficial nonsurgical treatment for patients who have chronically painful lumbar degenerative discs. Further studies would be optimal to confirm efficacy Key words: Viable disc tissue allograft, discogenic back pain, allograft supplementation, degenerative disc disease, low back pain, intervertebral disc, intradiscal injection

scholarly journals A comparative study of conventional microlumbar discectomy and endoscopic lumbar discectomies

2021 ◽  
Vol 8 (10) ◽  
pp. 3024
Author(s):  
Vyabhav Raghu ◽  
Deepak Ranade ◽  
Anil Patil ◽  
Sarang Gotecha ◽  
Prashant Punia ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Total Sample ◽  
Low Back ◽  
Tissue Destruction ◽  
Male Population ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Minimally Invasive Surgical

Background: Low back pain is fairly common in India and lumbar disc herniation is its most common specific cause. In the present study we compared three minimally invasive surgical modalities for treating lumbar disc herniation.Methods: This prospective observational study was conducted on patients who presented to our department with low back pain with radicular symptoms. Twenty-five patients who underwent either microlumbar disectomy (MLD), percutaneous endoscopic transforaminal lumbar discectomy (PELD) or microendoscopic lumbar discectomies (MED) were compared.Results: Of the total sample of 75 cases, it was found that male population was affected more and the degenerative disc process was more prevalent among those over 40 years of age. The MED had the shortest operative time while MLD had the longest mean duration. A comparison of the intraoperative blood loss was negligible in PELD group and 42.80 ml in MED and 63.20 ml in MLD which was strongly significant with a p<0.001. Pain scores were comparable between the patients in the three surgery groups. We observed significantly higher ODI score for patients in MLD group at in the immediate post-operative, 3 months and 6 months post-operative period.Conclusions: MLD is the gold standard for treatment for lumbar disc disease even today due to its familiarity among neurosurgeons; however, reduced tissue destruction and cosmetic demand with equally good results if not better, endoscopy could replace MLD as the first-line treatment for LDH until lesser invasive modality comes to light.

Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain: The Danish Health Examination Survey cohort 2007–2008

2018 ◽  
Vol 47 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Mie Balling ◽  
Teresa Holmberg ◽  
Christina B. Petersen ◽  
Mette Aadahl ◽  
Dan W. Meyrowitsch ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Vigorous Physical Activity ◽  
Sitting Time ◽  
Low Back ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Herniated Lumbar Disc

Aims: This study aimed to test the hypotheses that a high total sitting time and vigorous physical activity in leisure time increase the risk of low back pain and herniated lumbar disc disease. Methods: A total of 76,438 adults answered questions regarding their total sitting time and physical activity during leisure time in the Danish Health Examination Survey 2007–2008. Information on low back pain diagnoses up to 10 September 2015 was obtained from The National Patient Register. The mean follow-up time was 7.4 years. Data were analysed using Cox regression analysis with adjustment for potential confounders. Multiple imputations were performed for missing values. Results: During the follow-up period, 1796 individuals were diagnosed with low back pain, of whom 479 were diagnosed with herniated lumbar disc disease. Total sitting time was not associated with low back pain or herniated lumbar disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain (HR = 1.16, 95% CI: 1.03–1.30 and HR = 1.45, 95% CI: 1.15–1.83). Moderate, but not vigorous physical activity was associated with increased risk of herniated lumbar disc disease. Conclusions: The results suggest that total sitting time is not associated with low back pain, but moderate and vigorous physical activity is associated with increased risk of low back pain compared with light physical activity.

Sign in / Sign up

Export Citation Format

Share Document