Interlaminar epidural corticosteroid injection in the treatment of lumbosciatic pain: a retrospective analysis

Abstract

-Lumbosciatica is a common condition which is associated with significant pain and disability. The aim of the present study was to examine the efficacy of interlaminar epidural corticosteroid infiltration in the treatment of lumbosciatic pain. We evaluated retrospectively sixty patients with lumbosciatic pain that a sequential interlaminar epidural administration of 40 mg methylprednisolone in 7 mL bupivacaine 0.25% was administered. Each patient was interviewed and asked about the pain according to visual analogue scale (VAS) and the level of disability according to World Health Organization previously of the epidural corticosteroid infiltration and, 1 and, 6 months after starting therapy. Independently of the initial VAS value, all patients decreased their pain score after one and six months of follow-up (p<0.05). However, only the patients with a low grade of disability showed an improvement after the treatment (p<0.05). No side effects were reported after epidural corticosteroid injections. In conclusion, interlaminar epidural corticosteroid injection in association with local anesthetic may be useful, at least for six months, as additional therapy of the conservative management of lumbosciatic pain.KEY WORDS: epidural corticosteroid, herniated disc, pain, visual analogue scale. Injeção epidural interlaminar de corticóide no tratamento da dor da lombociatalgia: análise retrospectivaRESUMO -A lombociatalgia é condição clínica associada à dor intensa e alterações funcionais. O objetivo do presente estudo foi examinar a eficácia da infiltração de corticóide pela via epidural interlaminar no tratamento da dor da lombociatalgia. Foram avaliados, retrospectivamente, sessenta pacientes com lombociatalgia que foram submetidos à administração epidural interlaminar, em sequência, de 40 mg de metilprednisolona e 7 mL de bupivacaína a 0,25%. Os pacientes foram avaliados em relação à dor de acordo com a escala visual analógica (EVA) e o grau de comprometimento funcional de acordo com a Organização Mundial de Saúde antes e, uma e, seis meses após o início do tratamento. Independentemente do valor inicial da EVA, todos os pacientes diminuíram o escore de dor após um e, seis meses de acompanhamento (p<0.05). Entretanto, apenas os pacientes com baixo grau de comprometimento funcional apresentaram melhora após o tratamento (p<0.05). Não foram observados efeitos colaterais após as injeções de corticói-de epidural. Concluindo, a injeção epidural interlaminar de corticóide em associação com anestésico local pode ser benéfico, por pelo menos seis meses, como terapia coadjuvante no tratamento conservador da dor da lombociatalgia. PALAVRAS-CHAVE: corticóide epidural, hérnia de disco, dor, escala visual analógica.

Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis

“…However, in the remaining 1 study by Laiq et al, (2009) [24], no statistically significant improvement was observed, but 68% of the patients reported pain relief. In another study by Gomez et al, [27] baseline VAS score was ≥6 in 80% patients, and none of the patients had a VAS score of 0-2 at the baseline. At the last follow-up, greater than 70% of the patients achieved a VAS score between 0-5 with 60% of the patients having a VAS score of 0-2, representing a significant improvement post-EI treatment.…”

“…The NRS was used in 7 studies [1-2, 12, 17, 21, 23, 26], VAS used in 7 studies [16, 19-20, 22, 24, 27-28], and VNRS and JOA used in the remaining 2 studies [29-30]. …”

“…The ODI scores are reported in 9 studies [12, 17, 19-23, 25-26], RMDQ in 2 studies [2, 16], International Classification of Impairments, Disabilities, and Handicaps (ICIDH) by WHO Grade score in 1 study [27], and JOA score in 1 study [30]. In all of these studies, a significant improvement after EI was observed.…”

“…A study by Gomez et al, (2007) [27] reported a grading score system by WHO; Grades 2 & 3 and Grade 1 had 65% and 35% of patients, respectively; no patient was in Grade 0. Post-injection average of 76% of the patients moved to Grade 0-1 at the last follow-up, and 50% were in Grade 0.…”

“…We observed that particulate steroids [1-2, 17-18, 22-25, 27-28, 30] such as triamcinolone, methylprednisolone, and betamethasone have been used more commonly in the past ten years than the non-particulate steroids like dexamethasone. However, non-particulate steroids, such as dexamethasone have been suggested as a better option in the literature as they can avoid the potential complication of embolization of particulate steroids, such as Depo-Medrol into the feeder vessels of the spinal cord causing paraplegia [33].…”