Efficacy of ultrasound guided caudal epidural steroid injection with or without ozone in patients with lumbosacral canal stenosis; a randomized clinical controlled trial (original) (raw)
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Short Term Results of Single Shot Epidural Steroid Injection in Patients with Lumbar Canal Stenosis
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.2\_Feb2019/Abstract\_IJRR0024.html, 2019
Background: Epidural steroid injections (ESI) are commonly performed procedures for the management of lumbosacral radicular pain in lumbar canal stenosis cases. Epidural steroid injections are associated with reduced invasion, and may delay or prevent the need for more intensive surgery. Objectives: To study the pain relieving effect of epidural steroid in lumbar canal stenosis cases. Materials and Methods: Patients ranging from 18-75 years those suffering from lumbar canal stenosis with pain and radiculopathy symptoms for more than 6 months not relieved by conservative treatment (medications and physiotherapy) were given epidural steroid and pain relief at 1 day, 1 month and 3 month using VAS pain score was measured. Results: Study conducted on 25 patients of both sex and age between 18 yrs and 75 yrs within the period of 9 months and scoring was done using VAS score at the interval of 1 day, 1 month and 3 month at follow up. Data was tabulated and statistically analysed. Statistical analysis is done by comparing group using ANOVA test. Results were statistically significant for given interval of duration and p value is < 0.05. Conclusions: Our study showed that ESI are effective in decreasing pain in short term as measured by VAS scoring and the effect is more after 1 day of injection then 3 months , but the pain relieving effect is significant till the end of three months (indicated by p values).
Lumbar Intradiscal Ozone Chemonucleolysis applied together with the epidural steroid treatment
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital
L ow back pain is one of the most common causes of disability that causes economic loss by affecting social and work life. [1] About 85% of all people experience low back pain at least once in their lifetime. [2] Of the patients with low back pain, 10-15% has degenerative pathologies originating from specific nerve roots (lumbar disc herniation [LDH], and spinal stenosis) while the remaining 85% are diagnosed as "non-specific low back pain. [3] " While the majority of patients recover with conservative treatment or without treatment, 37-54% of patients still have pain after 1 year. [4] Minimally invasive methods can be utilized for patients not responding to standard Objectives: Intradiscal ozone treatment is a minimally-invasive method that can be applied to patients who have low back pain and do not respond to conservative treatment. This retrospectively designed study aimed to evaluate its clinical efficacy, adverse effects, or complication rates. Methods: Patients with lumbar degenerative disc disease (LDDD) who underwent intradiscal O 2-O 3 treatment between January 2016 and April 2018 were included in the study. Pain and disability levels were assessed at pre-injection, 1-month and 1-year postinjection periods using visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively. Results: A total of 520 patients (270 males and 250 females) with the mean age of 38.9±5.7 years included in the study. First-month and 1st-year post-injection VAS and ODI scores were significantly lower than pre-injection scores (p<0.001). Remarkable VAS score reduction (more than 50%) was found in 60.2% of patients at 1st month and in 52.9% of patients at the 1st year. No important side effects recorded. Conclusion: Intradiscal ozone therapy applied together with the epidural steroid treatment, one of the percutaneous application techniques for the treatment of low back pain related to LDDD, has successful outcomes, clinical efficacy, and low rate of side effects, and thus, is one of the methods that should be considered before surgery when appropriate patients.
Anesthesiology and Pain Medicine, 2020
Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r =-0.400, P < 0.001) and BMI (r =-0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r =-0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.
The Internet Journal of Pain, Symptom Control and Palliative Care
Objective: To determine pain relief and improvement in claudication distance after two doses of epidural steroid injections.Design: Prospective, randomised controlled trial performed in one hundred and twenty patients with clinical features of lumbar canal stenosis who received epidural medications for pain relief.Intervention: Patients were grouped into two; control group receiving injection of local anesthetic bupivacaine 4 ml (0.5%) diluted in normal saline and study group receiving 160mg methylprednisolone added to solution of bupivacaine 4ml (0.5%) and normal saline; both groups receiving equal volumes of 16 ml and bupivacaine in 0.125% concentrations. Pain relief was assessed post-procedurally by improvement in VAS pain scores and increase in the claudication distance. Results: Of the 120 patients followed for a period of 6 months 46% were females and 54% were males. In the study group 42 patients (70%) reported improvement in the VAS pain scores at the end of 6 months, compared to 9 (15%) patients in control group. The pre-intervention mean claudication distance was 128 meters in the study group and 130 meters in the control group; at the end of 6 month follow up was 694 m in the study group (P < .001) compared to 124 meters in the control group (P>0.05). In the study group, the average VAS scores decreased from 6.04 in pre-treatment phase to 3.14 at the end of 6 month follow up, which was significantly low (P<.05). Comparatively, in control group pre-treatment VAS score value decreased from 5.4 to 4.8 at 6 months of treatment (P>0.05). Conclusion: Injection of high dose of epidural steroids proved to be a safe, minimally invasive and cost effective method of treating lumbar canal stenosis and provided reasonably good relief for 6 months post-injection. We recommend using this intervention in routine clinical practice for treating lumbar canal stenosis.
Journal of Spinal Disorders & Techniques, 2012
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 related to lumbar spinal stenosis. Summary of Background Data: Multiple interventions including surgery and interventional techniques such as epidural injections and adhesiolysis are commonly performed in managing pain related to spinal stenosis. There is continuing debate on the effectiveness of all interventions, and a paucity of literature regarding effectiveness. Methods: One-hundred participants were randomly assigned to 1 of the 2 groups, with Group I participants receiving caudal epidural injections of local anesthetic (lidocaine 0.5%), whereas Group II participants received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid (nonparticulate Celestone). Outcomes Assessment: Multiple outcome measures were used, including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12 months posttreatment. Significant pain relief and improvement in disability were defined as 50% or more. Results: Overall, significant pain relief and functional status improvement (Z50%) were demonstrated in 48% in Group I and 46% in Group II. However, significant pain relief and functional status improvement were seen in 60% of the participants in both groups in the successful category when the participants were separated into successful and failed categories. The overall number of procedures was 3.1 ± 1.3 or 3.6 ± 1.1 in the successful category in Group I, with overall 2.9 ± 1.4 or 3.5 ± 1.2 in the successful category in Group II. Conclusion: Caudal epidural injections of local anesthetic with or without steroids may be an effective treatment for a select group of patients with chronic function-limiting low back and lower extremity pain secondary to spinal stenosis.
Pakistan Journal Of Neurological Surgery, 2021
Objective: This study aimed to determine the relation of severity of lumbar spinal stenosis and pain improvement after caudal epidural injection. Material and Methods: 70 patients of neurogenic claudication were included from July 2019 to June 2020. MRI lumbosacral spine was done of all patients to categorize the degree of spinal stenosis on T2-W axial. All patients were given caudal epidural steroid injection as a day case procedure. Follow-up was done at 3 & 8 weeks and pain improvement was assessed by using Ronald satisfaction score. Results: Mean age was 37.9 ± 7.8 years. 48.6% patients were male and 51.6% were female. The improvement was observed in 28 patients (40%) at 3 weeks and in 46 patients (65.7%) at 8 weeks. There was no statistically significant relationship between lumbar spinal stenosis and pain improvements at 3 weeks (p value 0.30) and 8 weeks (p value 0.32). Conclusion: The grade of lumbar spinal stenosis has no significant effect on pain improvement after...
Ultrasound-Guided Needling and Lidocaine Plus Sterile Water Injection in Lumbar Spinal Stenosis
2021
Objective: To study the effect of ultrasound-guided (USG) needling and lidocaine plus sterile water injections in lumbar spinal stenosis (LSS). Method: This retrospective study examined data of LSS patients who received USG lidocaine injection to lumbar facets, medial branches to facet joints, and multifidus muscles with one needle insertion at 4 spinal levels. Results: A total of 213 lumbar spinal stenosis patients--104 patients received USG needling and 1% lidocaine without adrenaline 2 ml plus sterile water 10 ml injection (Group A) and 109 patients received 1% lidocaine without adrenaline 6 ml injection (Group B)--for 4 times, once per week. The VAS of chronic low back pain, radicular pain, claudication, and walking ability of both groups at 3, 6, and 12 months were significantly better than the baseline. Group A reported significantly better chronic low back pain, radicular pain, claudication, and walking ability at 3, 6, and 12 months than Group B. Conclusions: USG needling an...
Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2020
of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis O ne of the degenerative pathologies of the lumbar spine is lumbar spinal stenosis (LSS) and it is a common cause of radicular pain. [1-3] The pathology appears as foramen, lateral recess and central stenosis on lumbar magnetic resonance image (MRI). The morphologic classification of LSS on lumbar MRI has been described by measuring the dural sac cross-sectional surface area in the literature. [4] The severe and extreme stenosis is treated with surgery generally and minor or moderate stenosis is treated conservatively. The complaints of patients are low back pain or bilaterally leg pain in a few patients. According to our clinical experience, especially in the foramen and lateral recess ste-Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically. Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year. Results: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks. It was 2.8±0.2, 3.1±0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6±0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3 after two weeks. It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months. Conclusion: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.
The Korean Journal of Pain
Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.
Pain Physician, 2012
Background: Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, there is a paucity of literature concerning the treatment of spinal stenosis symptoms. Multiple interventions, including surgery and interventional techniques such as epidural injections and adhesiolysis, are commonly utilized in managing pain related to central spinal stenosis. However, there is a paucity of literature from randomized, controlled trials about the effectiveness of epidural injections for lumbar central spinal stenosis. Objective: This study sought to assess the effectiveness of caudal epidural injections with or without steroids in providing effective and long-lasting pain relief for the management of chronic low back pain related to lumbar central stenosis. Study Design: A randomized, double-blind, active-controlled trial. Methods: One hundred patients were randomly assigned to one of 2 groups, with Gr...