129. Epidural Steroid Following Discectomy for Herniated Lumbar Disc Reduces Neurological Impairment and Enhances Recovery: A Randomized Study with Two Year Follow-up
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Epidural steroid injection
Discectomy
Objective To evaluate the therapeutic effects of one visit root canal therapy(RCT) and several visit RCT for cracked teeth.Methods Cracked teeth with pulposis or apical disease were randomized to receive one visit RCTor several visit RCT,their responses were compared.Results The long-term therapeutic effects of one visit RCT were batter than those of several visit RCT,but the differences were not significant.The concomitant symptoms were significantly less and treatment time was significantly shorter in one visit RCT group as compared with several visit RCT group.Conclusion One visit RCT is recommended for the RCT of cracked teeth.
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Background: Lumber prolapsed intervertebral disc induce radiating pain in lower limbs, for which epidural steroid injection is one of the safe and effective therapeutic option. This prospective study compares the results of 2 different techniques of transforaminal epidural steroid injection (TFESI) and subpedicular steroid injection in patients with prolapsed intervertebral disc (PIVD) in relieving lumbar radicular pain. Methods: Records of 80 patients who had undergone transforaminal and subpedicular epidural steroid injection for lumbar radicular pain were analyzed. Visual analogue scale (VAS) score were measured at before procedure and at 4th day post procedure and 2, 4, 6 and 24 weeks thereafter and straight leg raise test (SLRT) were measured before procedure, 4th day and 4 week post procedure. Results:At 24 weeks, the VAS was signicantly lower than the baseline in both groups; VAS in the TFESI group was signicantly lower than VAS in the subpedicular group at 6 and 24 weeks. SLRT score was signicantly higher in the TFESI group and subpedicular ESI group through the 4-week time point (P= 0.0021 at 4th day; P= 0.0001 at 4 weeks). At the end of 24 weeks, a signicantly greater number of patients in the TFESI group and subpedicular ESI showed difference In VAS (P = 0.0003). Conclusions: At the end of 24 weeks, TFESI appears to be a superior technique in relieving lumbar radicular pain in PIVD patients and could be an alternative to the subpedicular approach in severe spinal canal stenosis when it is hard to place the needle in the anterior epidural space through the safe triangle.
Epidural steroid injection
Radicular pain
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To The Editor:
I would like to compliment Dr. Buttermann on his well-conceived and executed study entitled “Treatment of Lumbar Disc Herniation: Epidural Steroid Injection Compared with Discectomy” (2004;86:670-9). This study supports the commonly held notion that discectomy provides rapid pain relief and accelerates recovery but does not promise a quantifiably better result in the long run.
However, the open crossover design muddies the results a bit. Would a design that prevented crossover, at least for a defined period of many months to a year (a common clinical scenario in managed-care and Workers' Compensation systems), have provided the same results?
It is unclear from my reading whether the timetable for the crossover group was in step with that for the steroid group or the surgical group. If the values recorded for monthly intervals were measured from the time of the epidural steroid injection, then these patients are included in some but not all of the datapoints in Figures 1, 2-A, and 2-B. These patients had at least some improvement when they opted to cross over, although the degree of that improvement is unknown. The “n” value for the “Epidural” group would have also changed during the early follow-up period.
On the other hand, if the timetable for the crossover group was reset to the time of …
Epidural steroid injection
Discectomy
Lumbar disc herniation
Disc herniation
Intervertebral Disc Displacement
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The efficacy of epidural steroid injection for sciatica due to herniated disc is controversial. This study evaluates the therapeutic effect of an alternative technique that uses a modified approach of epidural steroid injection for the above mentioned disease. The aim was to determine whether this procedure can reduce the need of surgery among discectomy candidates.Twenty-one eligible patients who had suffered from sciatica with unilateral symptoms for 2 to 24 months received injections of betamethasone in combination with xylocaine. The treatment outcome was evaluated by direct questioning and examination using the JOA score (the criteria for low back pain syndrome of Japanese Orthopaedic Association) before the procedure and at the final follow-up visit. The final analysis comprised 19 patients with a minimum of 24-month follow-up.The overall JOA score increased significantly from 14.26 +/- 3.25 before injection to 23.38 +/- 4.46 after injection showing improvement. In terms of subcategories, the JOA score for sciatica increased significantly from 0.69 +/- 0.48 before infection to 2.13 +/- 0.72 after injection and the JOA score for daily activity increased significantly from 7.44 +/- 2.16 before injection to 12.19 +/- 2.23 after injection). In the end, three treated patients received surgical decompression for intractable recurrent pain.Transforaminal epidural steroid injection is a relatively simple, effective and low-risk alternative to surgical decompression for the treatment of lumbar disc herniation in selected cases. The procedure significantly alleviates the severity of sciatica due to a herniated disc and improves the patient's daily activity; this reduces the need for surgical decompression.
Discectomy
Epidural steroid injection
Lumbar disc disease
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Background: Despite operative decompression of neural structure with discectomy in the indicated cases of lumbosacral disc herniation, many patients continue to experience back pain and leg pain in the postoperative period. Use of intraoperative local epidural steroid injection has been in practice to reduce this complications but there are concern and controversies regarding its benefit and risk. So this study aims to analyze clinical outcome in terms of reduction in pain, hospital stay, postoperative use of analgesics and risk associated with the use of intraoperative epidural steroid locally and comparison to those who did not receive steroid.
Methods: This was a retrospective analysis of total of 44 patients, 28 patients who received Epidural Steroid Injection (ESI) locally after lumbosacral standard discectomy and comparison of the outcome with results of 16 patients with standard lumbosacral discectomy who did not receive ESI. Outcome measurement was done between two groups in terms of postoperative pain VAS scale, use of analgesics, hospital stay and complications if any.
Results: There were total of 44 cases (28 steroid group and 16 no steroid group) with mean age of 39.93 years, male 27 and female 17 who underwent standard discectomy and followed up for at least one year. Overall, preoperative mean VAS score for pain improved from 7.95 to 1.55 at 1 year after operation which was significant p<0.05. On comparison of 24 hour postoperative VAS score and hospital stay between the groups with steroid and no steroid, it was mean of 5.32 versus 6 and 4.43 days versus 5.25 days (p<0.05) respectively which was significant. All the patients in no steroid group needed both NSAID and opioids for the postoperative pain management whereas only 12 (42.8%) patient needed addition of opioids in steroid group. There was no difference in VAS score at 1week and 1 year. There was no complications in either of the group.
Conclusions: Use of intraoperative ESI help to reduce early postoperative pain, hospital stay and use of opioids without adding further risk or complication.
Epidural steroid injection
Discectomy
Lumbosacral joint
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1 The Cleveland Clinic Spine Institute The Cleveland Clinic Foundation Cleveland, OH 44195 [email protected]
Discectomy
Disc herniation
Lumbar disc herniation
Epidural steroid injection
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Epidural steroid injection is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation. The objective of this study was to determine the efficacy of epidural steroid injection in the treatment of patients with a large, symptomatic lumbar herniated nucleus pulposus who are surgical candidates.One hundred and sixty-nine patients with a large herniation of the lumbar nucleus pulposus (a herniation of >25% of the cross-sectional area of the spinal canal) were followed over a three-year period. One hundred patients who had no improvement after a minimum of six weeks of noninvasive treatment were enrolled in a prospective, non-blinded study and were randomly assigned to receive either epidural steroid injection or discectomy. Evaluation was performed with the use of outcomes scales and neurological examination.Patients who had undergone discectomy had the most rapid decrease in symptoms, with 92% to 98% of the patients reporting that the treatment had been successful over the various follow-up periods. Only 42% to 56% of the fifty patients who had undergone the epidural steroid injection reported that the treatment had been effective. Those who did not obtain relief from the injection had a subsequent discectomy, and their outcomes did not appear to have been adversely affected by the delay in surgery resulting from the trial of epidural steroid injection.Epidural steroid injection was not as effective as discectomy with regard to reducing symptoms and disability associated with a large herniation of the lumbar disc. However, epidural steroid injection did have a role: it was found to be effective for up to three years by nearly one-half of the patients who had not had improvement with six or more weeks of noninvasive care.
Epidural steroid injection
Discectomy
Disc herniation
Lumbar disc herniation
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Objective To evaluate the clinical responses and effects after one visit RCT and several visits RCT. Meth-ods Cracked teeth with endodontitis or periapical disease were randomized into 2 groups according to they were treated by one visit RCT or several visits RCT,and their clinical responses and effects. Results The long-term effects of one visit RCT was better than that of several visits RCT. But There was no statistical differences between two groups. The clinical responses and treating time were reduced dramatically after one visit RCT was used. Conclusion One visit RCT is recom-mended for the cracked teeth RCT.
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Abstract Objective Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5–S1 disc herniation. Study design Prospective, randomized clinical trial. Setting A university hospital pain management center. Methods The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. Results A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3rd week and 3rd month compared to baseline (P < .001). Treatment success rate at 3rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (P = .766). Conclusions CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5–S1 disc herniation. Both approaches can reduce pain and disability, while CESI requires shorter fluoroscopy time and less radiation exposure.
Epidural steroid injection
Oswestry Disability Index
Radicular pain
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Background. Very elderly subjects (VES; aged 80 years or older) constitute a special population as they frequently present multiple diseases (polypathology). Results from trials on general adult populations therefore cannot be extrapolated to VES. We performed a census of randomized controlled trials (RCT) on VES published between 1990 and 2002, and carried out a descriptive and methodological analysis of these RCT/VES, comparing them with matched RCT on general adult populations (control RCT, RCT/C).
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