EVALUATION OF THE THERAPUTIC EFFICACY OF COMPUTED TOMOGRAPHY GUIDED PERIRADICULAR THERAPY IN PATIENTS WITH EXTRAFORAMINAL DISC HERNIATIONS

  • Dimitar Vasko Veljanovski PHI City General Hospital "8-mi Septemvri", Skopje, R of North Macedonia
  • Biljana Prgova PHI City General Hospital "8-mi Septemvri", Skopje, R of North Macedonia
  • Masha Kostova PHI City General Hospital "8-mi Septemvri", Skopje, R of North Macedonia
  • Milenko Kostov University Clinic for Neurosurgery, Faculty of Medicine, University „Ss. Cyril and Methodius” Skopje, R of North Macedonia
  • Ace Dodevski Institute of Anatomy, Faculty of Medicine, University „Ss. Cyril and Methodius”, Skopje, R of North Macedonia

Abstract

Periradicular therapy (PRT) is a minimally invasive radiological technique for treatment of chronic lumbar pain.The aim of this study was to investigate the efficacy of PRT in patients with chronic lumbar pain and radiculopathy due to extraforaminal disc herniation. The study included a prospective follow-up of 30 patients with chronic lumbar pain and radiculopathy. All patients underwent magnetic resonance imaging (MRI) and extraforaminal neuro-radicular conflict was detected. The degree of pain intensity was scored according to the VAS scale. The degree of improvement was presented as excellent (over 75%), good (50 -70%), intermediate (25-49%) and poor (less than 25%). Functional and working status was rated according to Oswestry Disability index2.0 (ODI). Follow-up of treated patients was at 2 weeks and 3 months. After 2 weeks the improvement was excellent in14 patients (47%), good in 7 patients (23%), moderate in 7 patients (23%) and mild in 2 patients (7%). Improvement after 3 months was excellent in 15 patients (50%), good in 7 patients (23%), moderate in 3 patients (10%) and poor in 5 patients (17%). The improvement of the functional status according to the ODI score was at least 40% in 73.3% of patients after 2 weeks and 86.5% of patients after the third month. CT controlled PRT in patients with lumbar radiculopathy is a safe and effective procedure leading to a significant pain reduction and a better quality of life after the procedure.


Keywords: epidural, steroid, lumbar, spine, radicular

References

1. Chou R. Low back pain (chronic). BMJ Clin Evid. 2010;2010:1116.
2. Palmer W E. Spinal injections for pain management. Radiology. 2016;281(3):669–88.
3. Fenster AJ, Fernandes K, Brook AL, Miller T. The safety of CT-guided epidural steroid injections in an older patient cohort. Pain Physician. 2016;19(8):E1139-E1146.
4. Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res. 2016;5:F1000 Faculty Rev-1530.
5. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96.
6. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2004;29(1):79-86.
7. Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39(4):619-26.
8. Manchikanti L, Singh V, Bakhit CE, Fellows B. Interventional techniques in the management of chronic pain: Part 1.0. Pain Physician. 2000;3(1):7-42
9. Marcia S, Zini C, Hirsch JA, Chandra RV, Bellini M. Steroids spinal injections. Semin Intervent Radiol. 2018;35(4):290-8.
10. MacVicar J, King W, Landers MH, Bogduk N. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med 2013;14(1):14–28
11. Ter Meulen BC, Weinstein H, Ostelo R, Koehler PJ. The epidural treatment of sciatica: its origin and evolution. Eur Neurol. 2016;75(1-2):58-64.
12. Murphy DR, Hurwitz EL, Gerrard JK, Clary R. Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome?. Chiropr Osteopat. 2009;17:9.
13. Gossner J. Safety of CT-guided lumbar nerve root infiltrations. Analysis of a two-year period. Interv Neuroradiol. 2014;20(5):533-7.
14. Manchikanti L, Cash KA, Pampati V, Falco FJ. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician. 2014;17(4):E489-E501.
15. Bhatti AB, Kim S. Role of epidural injections to prevent surgical intervention in patients with chronic sciatica: a systematic review and meta-analysis. Cureus. 2016;8(8):e723.
16. Eckel TS, Bartynski WS. Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol. 2009;12:11–21.
17. Manson NA, McKeon MD, Abraham EP. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series. Can J Surg. 2013;56(2):89-96.
18. Biyani A, Andersson GB. Low back pain: pathophysiology and management. J Am Acad Orthop Surg. 2004;12(2):106-15.
19.Ammendolia C. Degenerative lumbar spinal stenosis and its imposters: three case studies. J Can Chiropr Assoc. 2014;58(3):312-319.
20. Kaufmann TJ, Geske JR, Murthy NS, et al. Clinical effectiveness of single lumbar transforaminal epidural steroid injections. Pain Med. 2013;14(8):1126‐33.
21. Şencan S, Çelenlioğlu AE, Asadov R, Gündüz OH. Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica. Turk J Med Sci. 2020;50(1):126-131.
22. Heyes G, Jones M, Verzin E, McLorinan G, Darwish N, Eames N. Influence of timing of surgery on Cauda equina syndrome: outcomes at a national spinal centre. J Orthop. 2018;15(1):210-15.
23.Awad JN, Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:183-97
Published
2020-12-25
How to Cite
VELJANOVSKI, Dimitar Vasko et al. EVALUATION OF THE THERAPUTIC EFFICACY OF COMPUTED TOMOGRAPHY GUIDED PERIRADICULAR THERAPY IN PATIENTS WITH EXTRAFORAMINAL DISC HERNIATIONS. Journal of Morphological Sciences, [S.l.], v. 3, n. 3, p. 100-106, dec. 2020. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/150>. Date accessed: 28 jan. 2021.
Section
Articles