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Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği

Year 2019, Volume: 46 Issue: 3, 419 - 427, 16.09.2019

Mehmet Sabri Gürbüz

https://doi.org/10.5798/dicletip.620333

Abstract

Amaç: Lomber disk hernisine bağlı radikülopatili hastalarda lomber transforaminal epidural enjeksiyonun (TFEE) etkinliğinin araştırılması.  
Yöntemler: TFEE yapılan ve çalışma kriterlerini karşılayan 80 hasta retrospektif olarak incelendi. Tüm hastalara aynı yöntem ile C-kollu floroskopi eşliğinde, radikülopatinin olduğu taraf ve seviyeye, radyoopak madde ile hedeflenen foramen teyit edildikten sonra 40 mg metilprednisolon asetat ve 20 mg bupivacaine karışımı enjekte edildi. İşlem öncesi görsel analog skala (VAS) değerleri, işlem sonrası 3. saat, işlem sonrası 1. ay ve işlem sonrası 3. ay VAS değerleri ile karşılaştırıldı.VAS değerlerindeki azalma 0-%24,9, %25-49,9, %50-74,9 ve ≥%75 şeklinde sınıflandırıldı. Üçüncü ayın sonundaki VAS değerlerinde işlem öncesine göre en az % 50 azalma olan olgularda işlem başarılı kabul edildi. Ayrıca işlem başarısı ile yaş, cinsiyet, vücut kitle indeksi (VKİ) ve semptom süresi arasındaki ilişki değerlendirildi.  
Bulgular: Toplam 80 olgu arasından, 65 olguda (%81,3) işlem başarılı olurken, 15 olguda (%18,7) ise işlem başarısız olmuştur. Semptom süresi 6 aydan kısa olan olgularda başarı oranı % 80 iken, semptom süresi 6 ay ve daha uzun olan olguların başarı % 20 olarak saptanmıştır (p<0,01). Yaş, cinsiyet, seviye, taraf, VKİ ile işlem başarısı arasında anlamlı bir ilişki saptanmamıştır. VAS değerindeki azalma işlem sonrası 3. saatte ortalama %84; 1.ayda %71,9, 3.ayda ise %65,5 olarak saptanmıştır. 
Sonuçlar: Lomber disk hernisine bağlı radikülopatili hastalarda hasta seçimi iyi yapıldığında, TFEE ağrı kontrolü açısından orta vadede etkin bir yöntemdir. Semptom süresi 6 aydan uzun olan olgularda ise bu etkinlik azalmaktadır.  

Keywords

Lomber disk hernisi radikülopati transforaminal epidural enjeksiyon

References

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  • 2. Riew KD, Park JB, Cho YS, et all. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg. 2006; 88: 1722–5.
  • 3. Bernstein IA, Malik Q, Carville S, et all. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017; 6: 356: i6748.
  • 4. Riew KD, Yin Y, Gilula L, et all. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A pro-spective, randomized, controlled, double-blind study. J Bone Jt Surg Am. 2000; 11: 1589-93.
  • 5. Karppinen J, Malmivaara A, Kurunlahti M, et all. Periradicular infiltration for sciatica: a randomized con-trolled trial. Spine. 2001; 26: 1059-67.
  • 6. Lee JW, Kim SH, Choi JY, et all. Transforaminal epi-dural steroid injection for lumbosacral radiculopathy: Preganglionic versus conventional approach. Korean J Radiol. 2006; 7: 139-44.
  • 7. Jeong HS, Lee J, Kim SH, et all. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: A prospective randomized controlled study. Radiology. 2007; 245: 584-90.
  • 8. Vad VB, Bhat AL, Lutz GE, et all. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a pro-spective randomized study. Spine. 2002; 27: 11-6.
  • 9. Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc her-niation. Pain Med. 2011; 12: 871-9.
  • 10. Çetin MF, Karaman H, Kavak GÖ, et all. Lumbar radikülopatili hastalarda transforaminal lumbar epidural steroid enjeksiyonlarının etkinliği. Ağrı. 2012; 24: 77-84.
  • 11. Hoy D, Bain C, Williams G, et all. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64: 2028-37.
  • 12. Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a ran-domized, double-blind, controlled trial. Spine. 2005; 30: 857-62.
  • 13. Tafazal S, Ng L, Chaudhary N, et all. Corticosteroids in periradicular infiltration for radicular pain: a randomised double blind controlled trial. One year results and subgroup analysis. Eur Spine J. 2009; 8: 1220-25.
  • 14. Jeong HS, Lee J, Kim SH, et all. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: A prospective randomized controlled study. Radiology. 2007; 245: 584-90.
  • 15. Smith CC, Booker T, Schaufele MK, et all. Inter-laminar versus transforaminal epidural steroid injec-tions for the treatment of symptomatic lumbar spinal stenosis. Pain Med. 2010; 11: 1511-5.
  • 16. Park JW, Nam HS, Cho SK, et all. Kambin’s triangle approach of lumbar transforaminal epidural injection with spinal stenosis. Ann Rehabil Med. 2011; 35: 833-43.
  • 17. Chou R, Hashimoto R, Friedly J, et all. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015; 163: 373-81.
  • 18. McClain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: Mechanisms of action and efficacy. Spine J. 2005; 5: 191-201.
  • 19. Roberts ST, Willick SE, Rho ME, et all. Efficacy of lumbosacral transforaminal epidural steroid injections: A systematic review. PM R. 2009; 1: 657-68.
  • 20. Rosenberg SK, Grabinsky A, Kooser C, et all. Effectiveness of transforaminal epidural steroid injections in low back pain: A one-year experience. Pain Physician. 2002; 5: 266-70.
  • 21. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007; 104: 1217-22.
  • 22. Kabatas S, Cansever T, Yilmaz C, et all. Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Neurol India. 2010; 58: 242-58.
  • 23. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med. 2010; 11: 1149-68.
  • 24. 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: 89-96.
  • 25. Crow W, Willis D. Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. J Am Osteopath Assoc. 2009; 109: 229-33.
  • 26. Delport EG, Cucuzzella AR, Marley JK, et all. Treatment of lumbar spinal stenosis with epidural steroid injections: A retrospective outcome study. Arch Phys Med Rehabil. 2004; 85: 479-84.
  • 27. Botwin KP, Gruber RD, Bouchlas CG, et all. Fluoro-scopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis. An outcome study. Am J Phys Med Rehabil. 2002; 8: 898-905.
  • 28. Gharibo CG, Varlotta GP, Rhame EE, et all. Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study. Pain Physician. 2011; 14: 499-511.
  • 29. Cyteval C, Fesquet N, Thomas E, et all. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR. Am J Neuroradiol. 2006; 27: 978-82.
  • 30. Vad VB, Bhat AL, Lutz GE, et all. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (Phila Pa 1976). 2002; 27: 11-6.
  • 31. Kırcelli A, Yılmaz C. Lomber Disk Hernilerinde Kaudal ve Transforaminal Epidural Steroid Enjeksiyonlarının Birlikte Kullanımının Kısa ve Uzun Dönem Tedavi Sonuçlarına Etkisi. Türk Nöroşir Derg. 2016; 26: 49-54.

Year 2019, Volume: 46 Issue: 3, 419 - 427, 16.09.2019

Mehmet Sabri Gürbüz

https://doi.org/10.5798/dicletip.620333

Abstract

References

  • 1. MacVicar J, King W, Landers MH, et all. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med. 2013; 14: 14-28.
  • 2. Riew KD, Park JB, Cho YS, et all. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg. 2006; 88: 1722–5.
  • 3. Bernstein IA, Malik Q, Carville S, et all. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017; 6: 356: i6748.
  • 4. Riew KD, Yin Y, Gilula L, et all. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A pro-spective, randomized, controlled, double-blind study. J Bone Jt Surg Am. 2000; 11: 1589-93.
  • 5. Karppinen J, Malmivaara A, Kurunlahti M, et all. Periradicular infiltration for sciatica: a randomized con-trolled trial. Spine. 2001; 26: 1059-67.
  • 6. Lee JW, Kim SH, Choi JY, et all. Transforaminal epi-dural steroid injection for lumbosacral radiculopathy: Preganglionic versus conventional approach. Korean J Radiol. 2006; 7: 139-44.
  • 7. Jeong HS, Lee J, Kim SH, et all. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: A prospective randomized controlled study. Radiology. 2007; 245: 584-90.
  • 8. Vad VB, Bhat AL, Lutz GE, et all. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a pro-spective randomized study. Spine. 2002; 27: 11-6.
  • 9. Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc her-niation. Pain Med. 2011; 12: 871-9.
  • 10. Çetin MF, Karaman H, Kavak GÖ, et all. Lumbar radikülopatili hastalarda transforaminal lumbar epidural steroid enjeksiyonlarının etkinliği. Ağrı. 2012; 24: 77-84.
  • 11. Hoy D, Bain C, Williams G, et all. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64: 2028-37.
  • 12. Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a ran-domized, double-blind, controlled trial. Spine. 2005; 30: 857-62.
  • 13. Tafazal S, Ng L, Chaudhary N, et all. Corticosteroids in periradicular infiltration for radicular pain: a randomised double blind controlled trial. One year results and subgroup analysis. Eur Spine J. 2009; 8: 1220-25.
  • 14. Jeong HS, Lee J, Kim SH, et all. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: A prospective randomized controlled study. Radiology. 2007; 245: 584-90.
  • 15. Smith CC, Booker T, Schaufele MK, et all. Inter-laminar versus transforaminal epidural steroid injec-tions for the treatment of symptomatic lumbar spinal stenosis. Pain Med. 2010; 11: 1511-5.
  • 16. Park JW, Nam HS, Cho SK, et all. Kambin’s triangle approach of lumbar transforaminal epidural injection with spinal stenosis. Ann Rehabil Med. 2011; 35: 833-43.
  • 17. Chou R, Hashimoto R, Friedly J, et all. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015; 163: 373-81.
  • 18. McClain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: Mechanisms of action and efficacy. Spine J. 2005; 5: 191-201.
  • 19. Roberts ST, Willick SE, Rho ME, et all. Efficacy of lumbosacral transforaminal epidural steroid injections: A systematic review. PM R. 2009; 1: 657-68.
  • 20. Rosenberg SK, Grabinsky A, Kooser C, et all. Effectiveness of transforaminal epidural steroid injections in low back pain: A one-year experience. Pain Physician. 2002; 5: 266-70.
  • 21. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007; 104: 1217-22.
  • 22. Kabatas S, Cansever T, Yilmaz C, et all. Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Neurol India. 2010; 58: 242-58.
  • 23. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med. 2010; 11: 1149-68.
  • 24. 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: 89-96.
  • 25. Crow W, Willis D. Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. J Am Osteopath Assoc. 2009; 109: 229-33.
  • 26. Delport EG, Cucuzzella AR, Marley JK, et all. Treatment of lumbar spinal stenosis with epidural steroid injections: A retrospective outcome study. Arch Phys Med Rehabil. 2004; 85: 479-84.
  • 27. Botwin KP, Gruber RD, Bouchlas CG, et all. Fluoro-scopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis. An outcome study. Am J Phys Med Rehabil. 2002; 8: 898-905.
  • 28. Gharibo CG, Varlotta GP, Rhame EE, et all. Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study. Pain Physician. 2011; 14: 499-511.
  • 29. Cyteval C, Fesquet N, Thomas E, et all. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR. Am J Neuroradiol. 2006; 27: 978-82.
  • 30. Vad VB, Bhat AL, Lutz GE, et all. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (Phila Pa 1976). 2002; 27: 11-6.
  • 31. Kırcelli A, Yılmaz C. Lomber Disk Hernilerinde Kaudal ve Transforaminal Epidural Steroid Enjeksiyonlarının Birlikte Kullanımının Kısa ve Uzun Dönem Tedavi Sonuçlarına Etkisi. Türk Nöroşir Derg. 2016; 26: 49-54.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Mehmet Sabri Gürbüz 0000-0002-3764-389X

Publication Date September 16, 2019
Submission Date February 21, 2019
Published in Issue Year 2019 Volume: 46 Issue: 3

Cite

APA Gürbüz, M. S. (2019). Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği. Dicle Tıp Dergisi, 46(3), 419-427. https://doi.org/10.5798/dicletip.620333
AMA Gürbüz MS. Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği. diclemedj. September 2019;46(3):419-427. doi:10.5798/dicletip.620333
Chicago Gürbüz, Mehmet Sabri. “Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği”. Dicle Tıp Dergisi 46, no. 3 (September 2019): 419-27. https://doi.org/10.5798/dicletip.620333.
EndNote Gürbüz MS (September 1, 2019) Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği. Dicle Tıp Dergisi 46 3 419–427.
IEEE M. S. Gürbüz, “Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği”, diclemedj, vol. 46, no. 3, pp. 419–427, 2019, doi: 10.5798/dicletip.620333.
ISNAD Gürbüz, Mehmet Sabri. “Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği”. Dicle Tıp Dergisi 46/3 (September 2019), 419-427. https://doi.org/10.5798/dicletip.620333.
JAMA Gürbüz MS. Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği. diclemedj. 2019;46:419–427.
MLA Gürbüz, Mehmet Sabri. “Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği”. Dicle Tıp Dergisi, vol. 46, no. 3, 2019, pp. 419-27, doi:10.5798/dicletip.620333.
Vancouver Gürbüz MS. Lomber Disk Hernisine Bağlı Radikülopatili Hastalarda Floroskopi Eşlikli LomberTransforaminalEpidural Enjeksiyonun Etkinliği. diclemedj. 2019;46(3):419-27.