Alihan DERİNCEK, HATİCE EVREN EKER, Ayşin POURBAGHER, Murat Bekir ÇINAR, Metin ÖZALAY

Epidural steroid enjeksiyonu: Başarı tahmin edilebilir mi?

Giriş: Semptomatik lumbar disk herniasyonlu hastalarda, kanal darlık oranı ile epidural steroid enjeksiyonunun başarı oranı arasındaki ilişkinin belirlenmesidir. Materyal Metot: Lumbar disk hernisi nedeniyle bacak ağrısı şikayetiyle başvuran ve epidural steroid enjeksiyonu uygulanan hastalar çalışmaya dahil edildi. Aksiyel MR görüntülerinde kanal darlığının en fazla olduğu kesit ölçümler için seçildi. Kanal alanı ve disk herniasyon alanı; herbir kesit alanındaki toplam piksel sayısı, tarama düzeltme faktörü ile çarpılarak mm2/piksel cinsinden hesaplandı. Kanal darlık oranı; disk herniasyon alanının, kanal kesit alanına bölünüp 100 ile çarpılması ile hesaplandı. Ağrı değerlendirilmesi; enjeksiyon öncesi ve enjeksiyondan 1 ay sonra gerçekleştirilen görsel analog skala (GAS) skoru kullanılarak yapıldı. Ayrıca demografik bilgiler, semptom süresi, herniasyonun lokalizasyonu ve tipi not edildi. Bulgular: 14 erkek ve 25 bayan olmak üzere toplam 39 hasta çalışmaya dahil edildi. Ortalama yaş 50,2±11,6 idi (27-76). 21 hastada (%51) ek olarak bel ağrısı mevcuttu. Ortalama kanal darlık oranı %36,1±2,4 idi. Ortalama semptom süresi 19,4±6,6 ay idi. Enjeksiyon sonrası GAS skorunun, enjeksiyon öncesine göre istatistiksel olarak belirgin azalma gösterdiği saptandı (p0.05). Tartışma: Kısa semptom süresi ve yüksek oranda kanal darlığı olan hastaların, epidural steroid enjeksiyonundan daha fazla oranda fayda gördüğü gözlenmiştir.

Lumbar epidural steroid ınjection: Is the success rate predictable?

Introduction: The aim of this study is to determine the relation between the percent of canal compromise and success rate of epidural steroid injection (ESI) in patients with lumbar herniated intervertebral discs. Material and Methods: Patients with lumbar herniated intervertebral disc suffered from leg pain and treated with ESI were selected. The axial MRI showing the largest canal compromise by the herniated disc was selected for measurements. The canal and herniation area measurement were calculated from the number of pixels per cross-sectional area, multiplied by a scan correction factor, mm2 /pixel. The percent canal compromise was obtained by disc herniation area divided by canal cross-section area and multiplied by 100. For pain assessment, VAS was used before (pre-injection VAS) and a month after ESI (post-injection VAS). Demographic data, duration of symptoms, location and type of herniation were noted. Results: 39 patients were included in this study. Mean age was 50. 21 of cases also had back pain. Mean percent canal compromise ratio was 36,1%. Mean duration of symptoms was 19,4 months. The post-injection VAS was significantly decreased when compared with pre-injection VAS (p<0,0001) and this significance was related with if duration of symptoms shorter than 3 months (p=0,021). There was a significant negative correlation between percent canal compromise and post-injection VAS (p=0,042). There was no correlation between post-injection VAS and age, sex, location and type of herniation (p>0.05). Conclusion: The patient had shorter duration of symptoms and high percent of canal compromise could have more benefit from ESI.

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