Servikal ve lomber bölgelere uygulanan epidural steroid enjeksiyonunun etkinliğininkarşılaştırılması

Amaç: Epidural enjeksiyonlar, kronik bel-bacak ağrısı ve kronik boyun-kol ağrısı olan hastalarda kronik ağrı tedavisinde uzun yıllardır kullanılmaktadır. Lomber ve servikal epidural steroid enjeksiyonlarının ağrı palyasyonu, ağrı sağaltımı süresi ve hasta memnuniyeti üzerindeki etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif, gözlemsel tek merkezli bir çalışmadır. Servikal ve lomber bölgelere epidural steroid enjeksiyonu yapılan toplam 159 hasta (96 kadın, 63 erkek) çalışmaya dahil edildi. Hastalar lomber epidural steroid enjeksiyonu “Grup 1” ve servikal epidural steroid enjeksiyonu “Grup 2” olarak iki gruba ayrıldı. Hastalar enjeksiyon öncesi ve sonrası sayısal derecelendirme skalası (NRS), ağrı sağaltımı süresi, enjeksiyona bağlı gelişebilecek komplikasyonlar ve hasta memnuniyeti açısından geriye dönük olarak değerlendirildi. Bulgular: Grup 1’de 130, Grup 2’de 29 hasta değerlendirildi. İşlem öncesi medyan NRS: Grup 1’de 8, Grup 2’de 7 ve işlem sonrası medyan NRS: Grup 1’de 3, Grup 2’de 4; İşlemden hasta memnuniyeti Grup 1’de %56,15 ve Grup 2’de %48.6; ortalama ağrı sağaltımı süresi Grup 1’de 7.23 ay ve Grup 2’de 8.17 ay idi. Her iki grupta da işleme bağlı majör komplikasyon görülmedi. Değerlendirilen parametrelerde iki grup arasında istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Servikal ve lomber epidural steroid enjeksiyonları için ağrı palyasyonu, ağrı sağaltım süresi ve hasta memnuniyetinin benzer olduğu gözlendi.

Comparison of the eficacy of epidural steroid injection applied in cervical and lumbar regions

Objectives: Epidural injections have been used for many years in the treatment of chronic pain in patients with chronic backleg pain and chronic neck-arm pain. We aimed to compare the efficacy of lumbar and cervical epidural steroid injections on pain palliation, duration of pain relief and patient satisfaction. Methods: This is a Retrospective, observational single-center study. A total of 159 patients (96 females, 63 males) who were performed epidural steroid injections in cervical and lumbar regions were included in the study. The patients were divided into two groups as lumbar epidural steroid injection “Group 1” and cervical epidural steroid injection “Group 2”. We retrospectively evaluated the patients for numerical rating scale (NRS) prior and after the injection, the duration of the pain relief, whether any complication occured related to injection and patient satisfaction. Results: 130 patients in Group 1 and 29 patients in Group 2 were evaluated. Median NRS before the procedure: 8 in Group 1, 7 in Group 2 and median NRS after the procedure: 3 in Group 1, 4 in group 2. Patient satisfaction with the procedure 56.15% in Group 1 and 48.62% in Group 2. Mean duration of pain relief 7.23 months in Group 1 and 8.17 months in Group 2. There were no statistically significant difference in the evaluated parameters between the two groups. Conclusion: It was observed that the pain relief, duration of pain relief and patient satisfaction were similar for cervical and lumbar epidural steroid injections.

PDF

___

1. Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009;12(4):E35–70.
2. Shim E, Lee JW, Lee E, Ahn JM, Kang Y, Kang HS. Fluoroscopically guided epidural injections of the cervical and lumbar spine. Radiographics 2017;37(2):537–61.
3. Hall ED. Acute effects of intravenous glucocorticoid on cat spinal motor neuron electrical properties. Brain Res 1982;240(1):186–90.
4. Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 1990;34(5):335–8.
5. Chou R, Hashimoto R, Friedly J, Fu R, Dana T, Sullivan S, et al. Pain management injection therapies for low back pain [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2015.
6. Candido KD, Knezevic N’. Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain. Curr Pain Headache Rep 2013;17(2):314.
7. Briggs M, Closs JS. A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients. J Pain Symptom Manage 1999;18(6):438–46.
8. Rathmell JP. Atlas of image guided intervention in regional anesthesia and pain medicine. 2nd ed. Wolters Kluwer Lippincott Williams Wilkins; 2011. p: 35.
9. Gitkind Al, Olson TR, Downie SA. Vertebral artery anatomical variations as they relate to cervical transforaminal epidural steroid injections. Pain Med 2014;15(7):1109–14.
10. Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000;81(6):741–6.
11. Kesikburun S, Aras B, Kelle B, Yavuz F, Yaşar E, Taşkaynatan MA. The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results. Pain Manag 2018;8(5):321–6.
12. Lee DG, Chang MC. Effect of interlaminar epidural steroid injection in patients with central cervical spinal stenosis. World Neurosurg 2018;109:e150–4.
13. Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, et al. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol 2007;36(5):431–6.
14. Fish DE, Kobayashi HW, Chang TL, Pham Q. MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. Am J Phys Med Rehabil 2009;88(3):239–46.
15. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998;79(11):1362–6.
16. Taskaynatan MA, Tezel K, Yavuz F, Tan AK. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment. J Back Musculoskelet Rehabil 2015;28(3):447–51.
17. Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? a systematic review. Clin Orthop Relat Res 2015;473(6):1940–56.
18. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 2000;82(11):1589–93.
19. Riew KD, Park JB, Cho YS, Gilula L, Patel A, Lenke LG, et al. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am 2006;88(8):1722–5.