scholarly journals Efficacy of Ultrasono-Guided Caudal Epidural Steroid in Lumbar Disc Prolapse

KYAMC Journal ◽  
2020 ◽  
Vol 11 (2) ◽  
pp. 67-72
Author(s):  
Mohammad Moniruzzaman ◽  
Muhammad Alamgir Mandal ◽  
M Matiur Rahman ◽  
Syed Mozaffar Ahmed ◽  
Md Mustafizur Rahman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Mean Difference ◽  
Lumbar Pain ◽  
Minimal Risk ◽  
Low Back ◽  
Female Ratio ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: Ultrasono-guided caudal epidural steroid injections are used for the treatment of radicular lumbosacral pain syndromes with the safest, easiest, and minimal risk. Objective: The study is to show efficacy of ultrasono-guided caudal epidural steroid in acute and chronic low back pain due to prolapsed lumbar intervertebral disc (PLID). Materials and Methods: Thirty consecutive patients with acute and chronic low back pain with radiculopathy and without red flag sign where clinical diagnosis were prospectively included in this study in Popular Medical College Hospital, Dhanmondi, Dhaka. Results: The mean age was 40.83±13.34 (mean± SD). Male and female ratio was 3:2. Regarding diagnosis, 56.66% were acute and 43.33% were chronic low back pain in which 40% had lumbar canal stenosis, 70% had right sided radiation, 20% had left sided radiation and 10% had bilateral radiation. After 4 weeks, most of the study population was significantly improved regarding Visual Analogue Scale (VAS) score in lumbar pain and radiation pain, tenderness over lumbar spine, Straight Leg Raising (SLR) test and improvement of mean difference ± Standard Deviation (SD) after 4 weeks were 4.25±3.12, 4.58±1.58, 1.7±0.92 and 29.5±16.15 accordingly. Functional improvement of Oswestry Disability Index (ODI) from baseline 39.60±7.11 to 15.67±0.96. Mean difference of all variables were statistically significant. Conclusion: Ultrasound is an effective tool, not only to guide the insertion of the needle into the caudal epidural space, but also to predict the procedural success rate. KYAMC Journal Vol. 11, No.-2, July 2020, Page 67-72

scholarly journals Ultrasound-guided caudal epidural steroid injection in chronic radicular low back pain: short-term electrophysiologic benefits

BJR|Open ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 20190006
Author(s):  
Maha Emad Ibrahim ◽  
Magdy Ahmed Awadalla ◽  
Aziza Sayed Omar ◽  
Mohammad al-Shatouri
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Control Group ◽  
Low Back ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Short Term ◽  
F Wave ◽  
Epidural Steroid ◽  
Caudal Epidural

Objective: To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain. Methods: Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group (n = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml−1 Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group (n = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion. Results: Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment (p > 0.05). Conclusion: Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard. Advances in knowledge: This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.

Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis

2011 ◽  
Vol 26 (1) ◽  
pp. 10-20 ◽  
Author(s):  
Ligia M Pereira ◽  
Karen Obara ◽  
Josilainne M Dias ◽  
Maryela O Menacho ◽  
Débora A Guariglia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Mean Difference ◽  
Cochrane Central Register ◽  
Low Back ◽  
Inclusion Criteria ◽  
Lumbar Stabilization ◽  
Pilates Method

Objective: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. Data sources: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: ‘Pilates’, ‘Pilates-based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’ and ‘backache.’ Review methods: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95% confidence interval (CI) −2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = –1.99; 95% CI −4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = –0.31; 95% CI −1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI −1.02, 0.40; P = 0.39). Conclusion: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

scholarly journals Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain

2017 ◽  
Vol 1 (1) ◽  
pp. 15-21
Author(s):  
Saru Singh ◽  
Ruchi Gupta ◽  
Chashamjot Bawa ◽  
Lakshmi Mahajan ◽  
Bhanupreet Kaur ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomized Trial ◽  
Outcome Measures ◽  
Normal Saline ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Group Ii ◽  
Epidural Steroid ◽  
Epidural Steroids

ABSTRACT Introduction Low back pain behaves as a “silent epidemic,” ranking first among complications related to work. Often there is a large gap between a patient's desired pain reduction and the minimum percentage of improvement that would make a treatment worthwhile. Consequently, debate continues as to the value of epidural steroid injections, supremacy of one adjuvant over others, various doses, and concentrations in optimizing pain management. Objective To compare the efficacy of ketamine vs normal saline as an adjuvant to epidural steroids in chronic low back pain. Study design Randomized prospective placebo-controlled study. Materials and methods The study was conducted on 60 patients of age group 18 to 70 years having chronic lower backache with or without radiculitis of minimum 3 months duration and having no relief with conventional treatment. The patients selected were randomly allocated into two groups of 30 patients each: Group I (n = 30) given triamcinolone 40 mg, preservative-free ketamine 30 mg (0.6 mL) made up to 6 mL solution with 0.25% bupivacaine and group II (n = 30) given 0.6 mL normal saline instead of ketamine. Outcome measures The primary outcome measured was number of patients requiring repeat blocks and number of repeat blocks administered in 3 months. Other outcome measures were functional improvement quantified by visual analog scale (VAS) and Oswestry disability index (ODI) as well as improvement in psychological status by depression scoring, all taken at 2 weeks interval for 3 months. The periprocedural complications were also noted at the end of the study. Results In managing lumbar radicular pain with lumbar epidural steroid injection (LESI), ketamine's role as an adjuvant proved to be advantageous for long-term relief by its inhibition of dorsal horn “wind up” phenomenon through N-methyl-D-aspartate (NMDA) receptor antagonism, thus reducing frequency of repeat blocks in group II (ketamine). Conclusion Thus to conclude, ketamine's advantage as a drug that prolongs pain relief from LESI is an avenue for further research and promises a bright future in the field of interventional pain medicine. How to cite this article Gupta R, Bawa C, Singh S, Mahajan L, Kaur B, Kaur T. Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain. Curr Trends Diagn Treat 2017;1(1):15-21.

scholarly journals Evaluation of therapeutic efficacy of epidural steroid injections in lumbar spine with patients of chronic low back pain

2017 ◽  
Vol 3 (6) ◽  
pp. 1218
Author(s):  
Saket Jati ◽  
Mohammad Danish ◽  
Tanveer Sheikh ◽  
Ajay Varun
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Disc Herniation ◽  
Chronic Low Back Pain ◽  
Therapeutic Efficacy ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

<p class="abstract"><strong>Background:</strong> Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in managing chronic low back pain (LBP) along with surgical intervention. Cost effectiveness and affordability has become the cornerstone of evidence-based medicine, and has an influence on coverage decisions, especially in developing countries such as India. LBP is a common problem. The aim of this study was to find the therapeutic efficacy of epidural steroid injections (ESIs) in chronic LBP.</p><p class="abstract"><strong>Methods:</strong> 50 patients presenting with LBP with or without radiculopathy treated with ESIs were prospectively followed for average duration of 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Fifty patients were included in this study with average age 51.02±7.1, out of these 26 (52%) were males and 24 (48%) females. Significant pain relief (&gt;50%) was demonstrated in 43 (71%) of patients and functional status improvement was demonstrated by a reduction of 40% in Oswestry disability index (ODI) score in 49 (81%) patients.</p><p><strong>Conclusions:</strong> ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.</p>

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