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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
대한통증학회 The Korean Journal of Pain The Korean Journal of Pain 제27권 제4호
발행연도
2014.1
수록면
353 - 359 (7page)

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Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.
#epidural steroid injection #fluoroscopy #midline interlaminar #parasagittal interlaminar #transforaminal

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참고문헌 (16)

참고문헌 신청
Botwin K / 2004 / Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections : a prospective evaluation / Pain Physician 7 : 211 ~ 21 google schola Botwin KP / 2004 / Fluoroscopic guided lumbar interlaminar epidural injections : a prospective evaluation of epidurography contrast patterns and anatomical review of the epid google schola Buenaventura RM / 2009 / Systematic review of therapeutic lumbar transforaminal epidural steroid injections / Pain Physician 12 : 233 ~ 251 google schola Candido KD / 2008 / A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections : the lateral parasagittal in google schola Choi YK / 2009 / Evaluation of epidurographic contrast patterns with fluoroscopic-guided lumbar interlaminar ventral epidural injection / Pain Pract 9 : 275 ~ 281 google schola

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