Epidural application of steroids Part 1 – Patient profile before application


Authors: J. Cabadaj;  J. Hóborová;  M. Prokopová
Authors‘ workplace: Neurologická ambulance, Karlovarská krajská nemocnice a. s., Nemocnice Cheb
Published in: Cesk Slov Neurol N 2019; 82(6): 682-687
Category: Original Paper
doi: 10.14735/amcsnn2019682

Overview

Aim: As an alternative to surgical treatment of discogenic radicular pain following the failure of conventional conservative treatments, minimally invasive procedures are available, including epidural steroid injections (ESIs).

Patients and methods: The aim of the study was to find out and examine profiles of patients coming in for ESISs. Three hundred-forty patients were divided into the “D” – group of adult patients (aged 18–64 years) and the “S” – group of seniors (aged ≥ 65).

Results: Apart from the different average age, the results discovered in both groups were as comparable as when being divided into the groups according to the degree of their disabilities. In both groups, women predominated in the 1.4 : 1 and 2 : 1 ratios, resp. The average pain score was 4.9 and 55, resp. Oswestry Disability Index (ODI) was 40.3 and 40%, resp. Transforaminal ESI to caudal ESI ratio was 3 : 1 in both groups. More then 80 % of the patiens were in moderate and severe disability groups and ESI indications seem adequate. In both groups, the pain score increased according to the increasing degree of disability of the patiens. Compared to the literature data, patients in the cited studies were mostly younger and reported higher pain scores.

Conclusion: Pain assessment and the ODI questionnaire should be included in any entry examination of patiens with vertebrogenic pain as they will help in choosing an adequate treatment course.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


硬膜外应用类固醇激素第1部分–应用前的患者资料

目的:对于常规保守治疗失败后的椎间盘源性根性疼痛,可采用微创手术治疗,包括硬膜外类固醇注射(ESIs)。
患者和方法:这项研究的目的是确定和检查来自ESISs的病人的资料。 340例患者分为成人患者“ D”组(18-64岁)和老年人(“≥65岁”)“ S”组。
结果:除平均年龄不同外,两组的结果均与根据残疾程度分为两组的结果具有可比性。在这两组中,女性分别占1.4:1和2:1的比例。平均疼痛的评分分别为4.9和55。 Oswestry残疾指数(ODI)分别为40.3和40%。两组的经椎间孔ESI与尾ESI之比为3:1。超过80%的患者属于中度和重度残疾组,ESI适应症似乎足够。两组患者的疼痛评分均随着患者残疾程度的增加而增加。与文献数据相比,被引用研究中的患者大多为年轻人,并且疼痛评分更高。
结论:对于椎源性疼痛患者的入院检查应包括疼痛评估和ODI问卷调查,因为这将有助于选择适当的治疗方案。
关键词:硬膜外类固醇注射–患者概况– Oswestry残疾指数调查表

Keywords:

epidural steroid injection – patient profile – Oswestry Disability Index questionnaire


Sources

1. Tirpák R, Rapčan R, Griger M et al. Terapeutické možnosti a technika periradikulární terapie při kořenových syndromech. Bolest 2019; 22(1): 21–28.

2. Gabrhelík T, Lejčko J. Spinální aplikace kortikoidů. Bolest 2017; 20(1): 10–13.

3. Jandura J, Ryška P, Krajina A et al. Porovnání radiační zátěže u tří CT navigovaných minimálně invazivních metod léčby bolesti u nemocných s chronickým lumboischiadickým syndromem. Ces Radiol 2018; 72(3): 204–209.

4. Jandura J, Ryška P, Krajina A et al. Využití miniinvazivně prováděných metod – pulzní radiofrekvenční modulace, kyslíko ozonové terapie a periradikulární terapie v léčbě bolesti zad – přehled metod. Ces Radiol 2016; 70(2): 85–92.

5. Doubková M. Intervenční metody v léčbě bolesti zad – aneb co by měl začínající algeziolog znát před vstupem na intervenční sálek – 1. část. Bolest 2015; 18(2): 61–72.

6. Doubková M. Intervenční metody v léčbě bolesti zad – aneb co by měl začínající algeziolog znát před vstupem na intervenční sálek – 2. část. Bolest 2015; 18(3): 124–136.

7. Lejčko J. Bolesti zad – využití intervenčních technik v algesiologické praxi. In: Rokyta R et al (eds). Bolest. Praha: Tigris 2012: 115–128.

8. Hakl M. Invazivní postupy v léčbě bolesti zad. In: Rokyta R et al (eds). Bolest. Praha: Tigris 2012: 209–214.

9. Ševčík P, Hakl M, Hřib R. Použití epidurálních kortikosteroidů v léčbě vertebrogenních onemocnění. Neurol praxi 2002; 1: 21–24.

10. Epstein NE. Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections. Surg Neurol Int 2017; 8: 60. doi: 10.4103/ sni.sni_38_17.

11. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low back pain with radiculopathy: an up date of their efficacy and safety. Eur Spine J 2012; 21(2): 204–213. doi: 10.1007/ s00586-011-2007-z.

12. Pinto RZ, Maher CG, Ferreira ML et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med 2012; 157(12): 865–877.

13. Robecchi A, Capra R. Hydrocortisone (compound F); first clinical experiments in the field in the Rheumatology. Minerva Med 1952; 43(98): 1259–1263.

14. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998; 79(11): 1362–1366. doi: 10.1016/ s0003-9993(98)90228-3.

15. Dutka J, Kasík J. Léčba bolestí zad řízená výpočetní tomografií. Cesk Slov Neurol N 1995; 58/ 91(2): 81–84.

16. Kasík J. Intervenční léčba vertebrogenních koře­nových syndromů. Sanquis 2002; 18: 16.

17. Manchinati L. Transforaminal lumbar epidural steroid injections. Pain Physicain 2000; 3(4): 374–398.

18. Kao SC, Lin CS. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int 2017; 2017: 9217145. doi: 10.1155/ 2017/ 9217145.

19. Liu J, Zhou H, Lu L et al. The Effectivness of Transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain: a systematic review and meta-analysis. Medicine (Baltimore) 2016; 95(18): e3373. doi: 10.1097/ MD.0000000000003373.

20. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007; 104(5): 1217–1222. doi: 10.1213/ 01.ane.0000260307.16555.7f.

21. Mehta P, Syrop I, Singh JR et al. Systematic review of the efficacy od partikular versus nonpartikular cortikosteroids in epidural injektions. PM R 2017; 9(5): 502–512. doi: 10.1016/ j.pmrj.2016.11.008.

22. Fenster AJ, Fernandes K, Brook AL et al. The safety of CT – guided epidural steroid injektions in an older patient cohort pain physician. Pain Physician 2016; 19(8): E1139–E1146.

23. Farar JT, Young JP Jr, LaMoreaux L et al. Clinical Importance of changes in chronic pain intensity measured on an 11-point Numerical Pain Rating Scale. Pain 2001; 94(2): 149–158. doi: 10.1016/ s0304-3959(01)00349-9.

24. Fairbank JC, Couper J, Davies JB et al. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66(8): 271–273.

25. Baker D, Pynsent P, Fairbank J. The Oswestry Disability Index revisited. In: Roland J, Jenner J (eds). Back pain: new approaches to rehabilitation and education. Manchester, UK: Manchester University Press 1989: 174–186.

26. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000; 25(22): 2940–2953. doi: 10.1097/ 00007632-200011150-00017.

27. Mičánková Adamová B, Hnojčíková M, Vohaňka S et al.Oswestry dotazník, verze 2.1a –výsledky u pacientů s lumbální spinální stenózou, srovnání se starší verzí dotazníku. Cesk Slov Neurol N 2012; 75/ 108(4): 460–467.

28. Fairbank JC, Couper J, Davies JB et al. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66(8): 271–273.

29. Baker D, Pynsent P, Fairbank J. The Oswestry Disability Index revisited. In: Roland J, Jenner J (eds). Back pain: New approaches to rehabilitation and education. Manchester, UK: Manchester University Press 1989: 174–186.

30. Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 2000; 25(24): 3115–3124. doi: 10.1097/ 00007632-200012150-00006.

31. Vepřková P, Opavský J. Hodnocení bolesti a disability u pacientů s akutními a chronickými bolestmi dolní části zad. Bolest 2009; 12(4): 209–214.

32. MAPI Research Trust. [online]. Available from URL: https:/ / mapi-trust.org/ .

33. Taylor SJ, Taylor AE, Foy MA et al. Responsiveness of common outcome measures for patients with low back pain. Spine (Phila Pa 1976) 1999; 24(17): 1805–1812. doi: 10.1097/ 00007632-199909010-00010.

34. Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic rewiew. Rev Saude Publica 2015; 49. pii: S0034-89102015000100408. doi: 10.1590/ S0034-8910.2015049005874.

35. Balague F, Mannion AG, Pellise F. Clinical update low back pain. Lancet 2007; 369(9563): 726–728. doi: 10.1016/ S0140-6736(07)60340-7.

36. Mutto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminaloxygen-ozone (O2-O3) injektion. J Neuroradiol 2004; 31(3): 183–189. doi: 10.1016/ s0150-9861(04)96989-1.

37. Nováková E, Říha M. Vertebrogenní algický syndrom – medicína založená na důkazech a běžná klinická praxe. Existuje důvod něco změnit? Cesk Slov Neurol N 2017; 80/ 113(3): 280–284. doi: 10.14735/ amcsnn2017280.

38. Trinidad JM, Carnota AI, Faidle I et al. Radiofrequeny for the treatment of lumbar raicular paine: Impact on surgal indikations. Pain Res Treat 2015; 2015: 392856. doi: 10.1155/ 2015/ 392856.

39. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med 2010; 11(8): 1149–1168. doi: 10.1111/ j.1526-4637.2010.00908.x.

40. Ghahreman A, Frac S, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Med 2011; 12(6): 871–879. doi: 10.1111/ j.1526-4637.2011.01116.x.

41. Singh S, Singh K, Gupta R et al. Correlation of quality of life scores to clinical outcome of lumbar epidural steroids in chronic low back pain. Anesth Essays Res 2016; 10(3): 574–579. doi: 10.4103/ 0259-1162.183563.

42. Manchikanti L, Cash KA, Pampati V et al. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician 2014; 17(4): E489–E5014.

43. Manchikanti L, Singh V, Cash KA et al. A randomized, double-blind, active-control trial of the effectiveness of lumbar interlaminar epidural injections in disc herniation. Pain Physician 2014; 17(1): E61–E74.

44. Saqib M, Bhatti SN, Khan MA et al. Outcome analy­sis of two different injection solutions for epidural injection in radicular lumbar backache syndromes. J Ayub Med Coll Abbottabad 2016; 28(4): 709–714.

45. Nandi J, Chowdhery A. A randomized controlled clinical trial to determine the effectiveness of caudal epidural steroid injection in lumbosacral sciatica. J Clin Dia­gnRes 2017; 11(2): RC04–RC08. doi: 10.7860/ JCDR/ 2017/ 21905.9392.

46. Kennedy DJ, Plastaras C, Casey E. Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial. Pain Med 2014; 15(4): 548–555. doi: 10.1111/ pme.12325.

47. van Helvoirt H, Apeldoorn AT, Ostelo RW et al. Transforaminal epidural steroid injections followed by mechanical dia­gnosis and therapy to prevent surgery for lumbar disc herniation. Pain Med 2014; 15(7): 1100–1108. doi: 10.1111/ pme.12450.

48. Spijker-Huiges A, Winters JC, van Wijhe M et al. Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice. Musculoskelet Disord 2014; 15: 341. doi: 10.1186/ 1471-2474-15-341.

49. Kawu AA. Epidural steroid injection in patients with lumbosacral radiculopathy in Abuja, Nigeria. J Neurosci Rural Pract 2012; 3(2): 121–125. doi: 10.4103/ 0976-3147.98206.

50. Baral BK, Shrestha RR, Shrestha AB et al. Effectiveness of epidural steroid injection for the management of symptomatic herniated lumbar disc. Nepal Med Coll J 2011; 13(4): 303–307.

51. Manchikanti L, Singh V, Cash KA et al. A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis. Spine (Phila Pa 1976) 2011; 36(23): 1897–1905. doi: 10.1097/ BRS.0b013e31823294f2.

52. Manchikanti L, Cash KA, McManus CD et al. Preliminary results of a randomized, double-blind, controlled trial of fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar discogenic pain without disc herniation or radiculitis. Pain Physician 2010; 13(4): E279–E292.

53. Sayegh FE, Kenanidis EI, Papavasiliou KA et al. Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine (Phila Pa 1976) 2009; 34(14): 1441–447. doi: 10.1097/ BRS.0b013e3181a4804a.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2019 Issue 6

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account