Ultrasonografi rehberliğinde uygulanan kaudal epidural enjeksiyon sırasında sakral hiatusdaki anatomik farklılıklar ve başarı oranına etkisi

Amaç: Bu çalışmada kaudal epidural steroid enjeksiyonu (KESE) işlemi sırasında sakral hiatusun anatomik yapısındaki farklılıkları ultrasonografi (USG) eşliğinde incelemeyi, KESE sırasında ağrı düzeylerini ve başarı oranını değerlendirmeyi amaçladık. Gereç ve Yöntem: USG eşliğinde KESE uygulanan alt lomber bel ağrısı ve siyatik ağrısı olan 255 (148’i erkek, 107’i kadın) hasta çalışmaya dahil edildi. Tüm hastaların USG kılavuzluğunda sonogramları elde edildi. KESE işlemi esnasında hastaların ağrı düzeyleri vizüel analog skala (VAS) ile değerlendirildi ve başarı oranları kaydedildi. Anatomik hesaplamalarda interkornual mesafe, sakral mesafe ve sakrokoksigeal ligament kalınlığı ölçümü yapıldı. Bulgular: Hastaların demografik verileri arasında istatistiksel açıdan anlamlı bir fark saptanmadı (p>0.05). Erkeklerle kadınlar arasında, interkornual mesafe (16.6 mm’ye karşı 15.8; p=0.004) ve sakrokoksigeal ligament kalınlığı (4.1 mm’ye karşı 3.7 mm; p=0.018) açısından anlamlı bir fark vardı. KESE başarı oranı, VAS değerleri ve sakral mesafe açısından hastalar arasında anlamlı bir fark yoktu (p>0.05). Sonuç: Sakral hiatusun erkek ve kadın hastalar arasında anatomik farklılıklara sahip olduğunu tespit ettik. Mevcut kanıtlara göre USG eşliğinde sakral hiatusun anatomik yapıları doğru bir şekilde gösterildiğinde KESE’nin başarı oranı artmaktadır

Anatomical differences in sacral hiatus during caudal epidural injection with ultrasonography guidance and its effects on success rate

Objectives: To investigate the anatomical differences of sacral hiatus, pain levels and success rates during caudal epidural steroid injection (CESE) using ultrasonography. Methods: In the study, 255 patients (148 male and 107 female) with lower lumbar back pain and sciatica were included. These patients were applied caudal epidural steroid injection by ultrasonography. Sonograms were obtained by ultrasonography (USG) guideline. Patients’ pain levels were assessed by the Visual Analogue Scale (VAS) during the CESE procedure performed on USG guided, and success rates were saved. The intercornual distance, sacral distance and sacrococcygeal ligament thickness were measured. Results: There was no statistically significant difference between the demographic data of the patients (p>0.05). There was a significant difference between male and female patients concerning intercornual distance (15.8 versus 16.6 mm; p=0.004) and sacrococcygeal ligament thickness (4.1 mm vs. 3.7 mm; p=0.018). There was no significant difference between patients about KESE success rate, VAS values and sacral distance (p>0.05). Conclusion: We found that sacral hiatus has anatomical differences between male and female patients. According to current evidence, the success rate of caudal epidural steroid injection increased when the anatomical structures of sacral hiatus are shown correctly in USG guided.

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