Kronik Bel Ağrısının Tedavisinde Perkütan Epidural Nöroplasti Sonuçlarının Değerlendirilmesi

Abstract

AMAÇ: Lomber disk hernisi ve dejeneratif disk hastalığı, etkilenen dermatom boyunca alt ekstremiteye yayılan ağrı ile karakterize bir hastalıktır. Bu durum hastaların yaşam kaliteleri üzerinde olumsuz etkilere neden olabilir. Perkütan epidural nöroplasti, disk patolojilerinde uygulanan tedavi seçeneklerinden biridir. Çalışmamızda, Algoloji kliniğinde yapılmış olan perkütan epidural nöroplasti girişimlerinin sonuçlarını retrospektif olarak değerlendirmeyi ve karşılaştırmayı amaçladık. GEREÇ ve YÖNTEM: Algoloji Bilim Dalı’nda Ekim 2019-Ekim 2022 tarihleri arasında 3 aydan uzun süren bacak, sırt ve bel ağrısı şikayetiyle başvuran ASA I-III, 18-80 yaş, 60 hastada kaudal epidural girişim ile steroid + lokal anestezik + hiyaluronidazın ağrı kontrolündeki etkinlikleri retrospektif olarak değerlendirildi. Hastaların bel ağrılarının şiddeti Visual Analog Skala (VAS) ile, hastaların bel veya boyun ağrılarının günlük yaşamlarını nasıl etkilediği ve işlem sonrası bu etkilerin değişimi Oswestry Disability Scores (ODI) memnuniyet skoru ile işlem öncesi, işlem sonrası 1.ay, 3.ay, 6.aylarda değerlendirildi. BULGULAR: Çalışmamızda ağrı şiddetini VAS skoru ile hasta memnuniyeti ise ODI skalası ile değerlendirdik. Tüm hastaların lizis işleminden önce 7,75 ± 1,95 olan VAS değerinin 1., 3. Ve 6. ayda belirgin olarak azaldığı görüldü (p<0,05). İşlem öncesi 35,22 ± 7,79 olan ODI skalasının da 1., 3. Ve 6. ayda belirgin olarak azaldığı görüldü (p<0,05). Hem VAS skoru hem de ODI skalası yönünden her zaman diliminde bir önceki zamana göre istatistiksel olarak anlamlı şekilde azalma izlendi (p<0,05). SONUÇ: Perkütan epidural nöroplastinin, kronik bel ağrısı olan hastalarda ağrı, günlük fonksiyonlar ve yaşam kalitesinde olumlu etkilerinin olduğu gözlenmiştir. Kronik bel ağrısının tedavisinde, peruktan epidural nöroploasti etkili ve güvenilir bir tedavi yöntemidir.

Keywords

• Bel ağrısı
• nöroplasti
• lizis
• epidural

Evaluation of the Results of Percutaneous Epidural Neuroplasty in the Treatment of Chronic Low Back Pain

Abstract

OBJECTIVE: Lumbar disc herniation and degenerative disc disease is a common disease characterized by pain radiating to the lower extremities. This may have adverse effects on patients' quality of life. Percutaneous epidural neuroplasty is one of the treatment options applied in disc pathologies. In this study, we aimed to retrospectively evaluate and compare the results of percutaneous epidural neuroplasty interventions performed in the Algology clinic. MATERIAL and METHODS: In 60 ASA I-III, aged 18-80 years who applied to Department of Algology between October 2019-2022 with complaints of leg, back and low back pain longer than 3 months, caudal epidural intervention and the efficacy of steroid+local anesthetic+hyaluronidase in pain control was followed up in a retrospective. The severity of pain of the patients was evaluated by Visual Analog Scale (VAS). Disability The scores (ODI) were evaluated with the satisfaction score before the procedure, at the 1st, 3rd and 6th months after the procedure. RESULTS: In our study, we evaluated pain severity with VAS score and patient satisfaction with ODI scale. It was observed that the VAS value of all patients, which was 7.75 ± 1.95 before the lysis procedure, decreased significantly in the 1st, 3rd and 6th months (p<0.05). It was observed that the ODI scale, which was 35.22 ± 7.79 before the procedure, decreased significantly in the 1st, 3rd and 6th months (p<0.05). A statistically significant decrease was observed in both VAS score and ODI scale in each time period compared to the previous time (p<0.05). CONCLUSION: It has been observed that percutaneous epidural neuroplasty has positive effects on pain, daily functions and quality of life in patients with chronic low back pain. In the treatment of chronic low back pain, percutaneous epidural neuroploastia is an effective and safe treatment method.

Keywords

• low back pain
• neuroplasty
• lysis
• epidural

References

1. 1. Manchikanti L, Staats PS, Sigh V, Schultz DM, Vilims BD, Jasper JF, Trescot AM, Hansen HL, Falasca TD, Racz GB, Deer TR, Burton AW, Caladney AK, Feler CA. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 2003; 6(1):3-81.
2. 2. Süslü H,Süslü HT,Tatarli N,Ceylan D,Güçlü B, Karabagli H, Influence of prior lumbosacral surgery on the incidence of intravascular injection during transforaminal epidural injections. Journal of Neurological Sciences 2015; 32(1):161-9.
3. 3. Ji GY, Oh CH, Won KS, Han IB,Ha Y, Shin DA, Kim KN. Randomized controlled study of percutaneous epidural neuroplasty using Racz catheter and epidural steroid injection in cervical disc disease. Pain Physician 2016; 19(2):39-48.
4. 4.Hellsing AL, Bryngelsson IL. Predictors of musculoskeletal pain in men: A twenty-year follow-up from examination at enlistment. Spine 2000; 25(23):3080-6.
5. 5. Park EJ, Park SY, Lee SJ, Kim NS, Koh DY.Clinical outcomes of epidural neuroplasty for cervical disc herniation. J Korean Med Sci 2013; 28(3):461-5.
6. 6. Lee JH, Lee SH. Clinical effectiveness of Percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician 2012; 15(3):213-21.
7. 7. Manchikanti L, Pampati V, Cash KA. Protocol for evaluation of the comparative effectiveness of percutaneous adhesiolysis and caudal epidural steroid injections in low back and/or lower extremity pain without post surgery syndrome or spinal stenosis. Pain Physician 2010; 13(2):E91-E110.
8. 8. Anderson SR, Racz GB, Heavner J. Evolution of epidural lysis of adhesions. Pain Physician 2000; 3(3):262-70.

9. 9. Scuderi GJ, Brusovanik GV, Anderson DG, Dunham CJ, Vaccaro AR, Demeo RF, Hallab N. Cytokine assay of the epidural space lavage in patients with lumbar intervertebral disk herniation and radiculopathy. J Spinal Disord Tech 2006; 19(4):266-9.
10. 10. Hogan QH. Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease. Reg. Anesth 1996; 21(5):395-406.
11. 11. Devulder J, Deene P, De Laat M, Van Bastelaere M, Brusselmans G, Rolly G. Nerve root sleeve injections in patients with failed back surgery syndrome: A comparison of three solutions. Clin. J. Pain 1999; 15(2):132–5.
12. 12. McCleaneGJ. Caudal epidural hyaluronidase can significantly reduce the pain associated with failed back surgery syndrome. Pain Clin 2001; 13(2):119–23.
13. 13. Park CH, Lee SH. Effectiveness of percutaneous transforaminal adhesiolysis in patients with lumbar neuroforaminal spinal stenosis. Pain Physician 2013; 16(1):E37-43.
14. 14. Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: A randomized, equivalence controlled trial. Pain Physician 2009; 12(6):E355-68.
15. 15. Lee JH, Lee SH. Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician 2012; 15(3):213-21.
16. 16. Öncü J, İlişer R, Çelebi G, Kuran B, Durlanık G. Lomber Diskopati Tanılı Olgulara Uyguladığımız Epidural Kortikosteroid Enjeksiyonunun Klinik Sonuçları. Şişli Etfal Hastanesi Tıp Bülteni 2014; 48(1):34-8.
17. 17. Fritz JM, Irrgang JJ. A. Comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy 2001; 81:776- 88.
18. 18. Koç M, Bayar K. Fonksiyonel Bel Ağrısı Skalası’nın Türkçe Uyarlaması: Geçerlik ve güvenirlik çalışması J Exerc Ther Rehabil 2017; 4(2):82-9.