The Impact of Vitamin D Deficiency to Treatment Success of Transforaminal Epidural Steroid Injection.
1
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Transforaminal epidural steroid injection (TFESI) is an interventional technique used to relieve disc herniation related back and radicular pain. Although few studies have investigated the factors predicting positive outcomes after TFESI, there is no data concerning the possible relationship between pre-procedure serum 25-hydroxyvitamin D (25(OH)D) levels and the response to TFESI.To investigate the effect of vitamin D deficiency to treatment success of fluoroscopy-guided transforaminal epidural steroid injection.A retrospective assessment.A university hospital interventional pain management center.Nine hundred forty-eight patients received lumbosacral TFESI between January 2018 and December 2019 in a university hospital pain management center and were examined retrospectively for eligibility. Clinical and demographic data; magnetic resonance imaging (MRI); pre-procedure laboratory tests, including serum 25(OH)D; pain scores at baseline, third week, and third month follow-ups were collected.A total of 83 patients were recruited and divided into 2 groups with respect to vitamin D status. The number of patients with serum 25(OH)D level below 20 ng/mL was 57 and the number of patients with serum 25(OH)D level above 20 ng/mL was 26. Treatment success rates were significantly lower in vitamin D deficient group at third week and third month (P: 0.006, P: 0.01).Retrospective nature and the absence of functional outcomes.Vitamin D deficiency is associated with a lower probability of meaningful pain relief following TFESI. It may worth assessing serum vitamin D level prior to this intervention, although prospective investigation is necessary.Keywords:
Epidural steroid injection
Single Center
Radicular pain
Back Pain
Cite
Radicular pain
Epidural steroid injection
Etiology
Referred pain
Back Pain
Facet (psychology)
Cite
Citations (0)
The frequency and characteristics of definite lumbar scoliosis in an adult common low-back pain population (n = 671) were assessed by a clinical and radiologic prospective study. The prevalence was 7.5% [N = 50], increasing with age: 2% before 45 years; 15% after 60 years. Scoliosis was revealed by low-back pain in adult-hood in 86% of the cases. The mean Cobb angle was 21 pL 11.4o, A Cobb angle of more than 30o was noted in 16% of the scoliotics, thus 1% of the entire population. The proportion of women increased with the severity of the scoliosis. Right and left side scolioses were equally noted. A correlation between the Cobb angle and age was found (0.3o/Yr; P < 0.05). Rotatory olisthesis was noted in 34% of the cases, more often in right side curves (P < 0.01). The lumbar scoliotc patients were distinguished by a more advanced age (62 pL 12.4 Yr vs. 49.6 pL 15.5 Yr; P < 0.001), a greater proportion of women (72% vs, 48%; P < 0.01), and a more likely in volvement of L3 and L4 radicular pain (P < 0.05). Ridicular thigh pain was related to unstable curves (P < 0.01). The lumbar scoliotic patients thus constitute a subgroup within the low-back pain population.
Cobb angle
Radicular pain
Back Pain
CobB
Cite
Citations (180)
The role of lumbar spine arthrodesis in the treatment of low back pain disorders remains a highly disputed and controversial subject. There are no clear-cut indications for lumbar spine fusion in lumbar degenerative disc disease. In fact, lumbosacral fusion when added to appropriate decompressive surgery has failed on careful statistical analysis to significantly improve the results over decompressive surgery alone. Moreover, in several large series in the literature of lumbosacral fusion in conjunction with discectomy, the results in patients who developed a pseudoarthrosis did as well as matched cases who obtained an excellent arthrodesis. These results should not be surprising since there does not appear to exist a generally accepted operational definition of mechanical (lumbar instability) pain. The author, however, is of the opinion that lumbosacral arthrodesis will prove to have a definite, albeit small, role in the management of the intractable and incapacitating low back pain disorders. This is based on personal clinical experience and the belief that the phenomenon of intractable and incapacitating mechanical low back pain syndromes do exist. Carefully performed prospective clinical studies are requisite to define the mechanical low back pain syndrome and the role of lumbar arthrodesis in the treatment of the low back pain disorders. Given our present limitations, the author suggests that lumbosacral arthrodesis be reserved for patients suffering spondylotic low back pain syndromes who have the following characteristics: intractable and disabling pain; primary complaint of segmental mechanical pain; radiologic evidence consistent with "instability"; minimal or no segmental disease above proposed site of arthrodesis; and minimal or absent psychosocial-economic pain.
Lumbosacral joint
Back Pain
Intractable pain
Lumbar disc disease
Cite
Citations (6)
Retrospective investigation of cross-sectional data.To define the prevalence and determinants of preoperative vitamin D deficiency among adults undergoing spinal fusion.Vitamin D plays a critical role in establishing optimal bone health, which, in turn, is vital to the success of spinal arthrodesis. Recently, hypovitaminosis D was documented in 43% of adults undergoing any orthopedic surgery.Serum 25-hydroxyvitamin D levels were routinely measured in adults undergoing spinal fusion at a single institution. Between January 2010 and March 2011, 313 patients were retrospectively identified for inclusion. Risk factors for vitamin D deficiency (<20 ng/mL) were analyzed using univariate analysis and multivariate logistic regression.The rates of inadequacy (<30 ng/mL) and deficiency were 57% and 27%, respectively. Although 260 patients were diagnosed with degenerative disease (spondylosis), 99 had deformity, and there were 73 revision cases. There was a higher rate of smoking (P = 0.03) and lower age (P < 0.01) in the vitamin D-deficient subset. There was no sex difference. Increasing body mass index (P < 0.01), increasing Neck and Oswestry Disability Index scores (P = 0.03), and lack of vitamin D and/or multivitamin supplementation (P < 0.01) remained predictors of deficiency after multivariate analysis. Those with previous supplementation were older (P < 0.01) and more likely to be at least 50 years old than those without repletion (P < 0.01).Our investigation revealed a substantially high prevalence of vitamin D abnormality in the analyzed population. Although advanced age is a well-established risk factor for hypovitaminosis, young adults undergoing fusion should not be overlooked with regard to vitamin D screening; this age bracket is less likely to have been previously supplemented. In the absence of better-recognized determinants, spinal disability indices may also be useful in identifying those with deficiency.
Univariate analysis
Cite
Citations (91)
A survey was done of 250 patients with low back pain and sciatica, treated as outpatients in a pain relief practice, with epidural steroid injections. Repeated injections improved the success rate and provided a safe, cost effective means of treatment without the necessity of hospital admission.
Lumbosacral joint
Epidural steroid injection
Cite
Citations (23)
The authors studied the plain radiographs and medical records of 5000 military recruits, mean age 19.1 years (range: 18 to 22), screened in a Turkish Military Hospital in the period November 2008-October 2009. They focused on the incidence of congenital lumbosacral malformations, such as spina bifida occulta and transitional vertebra, trying to find a correlation with subsequent low back complaints. Only 80 out of 748 subjects (10.7%) with low back complaints had one or more malformations, versus 744 out of 4252 subjects (17.5%) without low back complaints. This pleaded against a correlation between malformations and low back disorders. Also the literature is completely divided as to this problem, which means that there is probably no correlation at all. Interestingly, the 80 subjects with low back complaints and malformation estimated their pain level at +/- 4.6 on a Visual Analog Scale for pain, while the 668 with low back complaints but without malformation estimated their pain level at only +/- 2.2 (p = 0.007). At least two other studies led to the same conclusion. This paradox might be due to the fact that congenital malformations concentrate all external stress on the adjacent levels.
Spina bifida occulta
Lumbosacral joint
Congenital malformations
Cite
Citations (11)
In cases in which operation is indicated, the author advocates routine fusion of the lumbosacral joint in all cases of protrusion of the 5th lumbar disc, providing the spine above that level is considered essentially normal.He would do spinal fusion in all cases-provided operation were indicated-in which the primary complaint was that of low back pain and in which sciatic pain was absent or minimal. In such cases, the fusion area should extend as far as necessary to include the portion of the spine involved in pathologic change. Only in exceptional cases would spinal fusion be done in patients more than 50 years of age. With the exceptions noted, all patients requiring reoperation should have the benefits of lumbosacral fusion.
Lumbosacral joint
Back Pain
Cite
Citations (0)
Cauda equina
Lumbar Nerve
Lumbosacral joint
Intervertebral foramen
Radicular pain
Back Pain
Intervertebral Disc
Cite
Citations (3)
ABSTRACT Results of surgical or non-surgical treatment of patients with chronic persistent low back pain, but without clearly demonstrable diagnosis of disc herniation, spinal stenosis, or spinal instability, range between 50% to 80% of success rates in the literature. Between 1984 and 1988, the authors reviewed 25 consecutive cases of internal derangements of the lumbar disc treated by subtotal disc excision and interbody fusion. AU patients had chronic, persistent, or frequently recurring low back pain resistant to active nonoperative treatments for a minimum of 3 months (mean: 16); no evidence of disc herniation, stenosis, or instability; no previous operation; single level of the pathologic condition in L-S spine; and diagnosis made by clinical information, CT, MRI, and/or discography. Ages ranged from 25 to 51 (mean: 38 to 40). Average follow up was 2 years (range: 13 to 57 months). In addition, 20 patients (32 discographies) who had available information of discography, MRI, and CT scan of the L-S spine, were reviewed for the relationship between disc morphology, pressure, volume, and pain response during discography. Overall clinical results for the 25 patients were: 58% excellent (15 of 26), 31% good (8 of 26), and 11% fair (3 of 26). No patients were in the "poor" category. The successful fusion rate was 95%.
Discography
Lumbosacral joint
Back Pain
Disc herniation
Cite
Citations (34)
Lumbar disc herniation
Radicular pain
Lateral recess
Back Pain
Disc herniation
Cite
Citations (11)