NON-OPERE TEK MESAFE LOMBER DİSK HERNİASYONLARINDA TRANSFORAMİNAL EPİDURAL STEROİD ENJEKSİYONU ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

Öz

AMAÇ: Lomber disk hernilerinde (LDH) minimal invaziv bir girişim olan transforaminal epidural steroid enjeksiyonu (TESE) uygulaması hastaların ağrılarını önemli ölçüde azaltılabilir. Çalışmamızda radikülopatik semptomları olan, cerrahi işlem uygulanmamış tek mesafe LDH olgularında TESE’nin etkinliğinin değerlendirilmesi amaçlandı. GEREÇ VE YÖNTEM: 2007- 2011 tarihleri arası, TESE uygulanmış hastaların medikal kayıtları retrospektif olarak incelendi. TESE girişimi öncesinde ve sonrasında ilk 6 aylık kontrollerindeki vizüel analog skala (VAS), düz bacak kaldırma (DBK) testi ve hasta memnuniyet skorları değerlendirildi. BULGULAR: 105 hasta (21 erkek, 84 kadın) değerlendirildi. Kontrol VAS ve DBK testi değerleri girişim öncesi değerlerle kıyaslandığında anlamlı iyileşmeler olduğu saptandı. Olguların 1, 3. ve 6. ay kontrol VAS değerleri, girişim öncesi VAS değerlerine göre anlamlı derecede düşük bulundu (p<0.001). Olguların 1, 3. ve 6. ay DBK testi değerlerinde de girişim öncesi DBK testi değerlerine göre istatistiksel olarak anlamlı derecede düzelme olduğu görüldü (p<0.001). Girişim öncesi VAS’a göre 1. ay kontrol VAS’da %85,71 başarı, 3. ay VAS’da %87,62 başarı ve 6. ay VAS’da %47,62 başarı elde edildi. TESE sonrası 1. ayda hastalarda %95.2, 3. ayda %93.3, 6. ayda ise %86.7 oranında hasta memnuniyeti görüldü. SONUÇ: LDH’ne bağlı olarak gelişen radikülopatik ağrıda TESE uygulanabilecek minimal invaziv bir yöntemdir.

Anahtar Kelimeler

• Lomber disk hernisi
• Transforaminal epidural steroid enjeksiyonu
• Ağrı

EVALUTION OF THE EFFICACY OF TRANSFORAMINAL EPIDURAL STEROID INJECTION IN NON-OPERATED SINGLE LEVEL LUMBAR DISC HERNIATIONS

Öz

OBJECTIVE: Transforaminal epidural steroid injection (TESE), which is one of the minimally invasive procedures in lumbar disc herniations (LDH), can significantly reduce the pain of patients. In our study, it was aimed to evaluate the efficacy of TESE in patients with radiculopathic symptoms and single-distance LDH who did not undergo surgery. MATERIAL AND METHODS: Medical records of patients who underwent TESE between 2007 and 2011 were reviewed retrospectively. Visual analog scale (VAS), straight leg lift (DBK) test, and patient satisfaction scores were evaluated before and after the TESE procedure in the first 6 months of follow-up. RESULTS: 105 patients (21 men, 84 women) were evaluated. When the control VAS and DBK test values were compared with the pre-intervention values, and significant improvements were detected. The 1st, 3rd, and 6th-month control VAS values of the cases were found to be significantly lower than the pre-intervention VAS values (p<0.001). It was observed that there was a statistically significant improvement in the 1st, 3rd, and 6th-month DBC test values of the cases compared to the pre-intervention DBC test values (p<0.001). According to the pre-interventional VAS, 85.71% success was achieved in the 1st -month control VAS, 87.62% success in the 3rd month VAS and 47.62% in the 6th month VAS. After TESE, patient satisfaction was 95.2% in the 1st month, 93.3% in the 3rd month, and 86.7% in the 6th month. CONCLUSIONS: TESE is a minimally invasive method that can be applied in radiculopathic pain due to LDH.

Anahtar Kelimeler

• Lumbar disc hernia
• Transforaminal epidural steroid injection
• Pain

Kaynakça

1. 1. Costa-Black KM, Loisel P, Anema JR, Pransky G. Back pain and work. Best Pract Res Clin Rheumatol. 2010;24(2):227-40.
2. 2. Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach; a prospective randomized controlled study. Radiology. 2007;245:584-90.
3. 3. Van Zundert J, Van Kleef M. Low back pain from algorithm to cost- effectiveness? Pain Pract. 2005;5:179-89.
4. 4. Leung SM, Chau WW, Law SW, Fung KY. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J. 2015;21(5):394-400.
5. 5. Manchikanti L, Pampati V, Boswell MV, Smith HS, Hirsch JA. Analysis of the growth of epidural injections and costs in the Medicare population: A comparative evaluation of 1997, 2002 and 2006 data. Pain Physician. 2010;13:199-212.
6. 6. Rosenberg SK, Grabinsky A, Kooser C, Boswell MV. Effectiveness of transforaminal epidural steroid injections in low back pain: a one year experience. Pain Physician. 2002;5:266-70.
7. 7. Roberts ST, Willick SE, Rho ME, Rittenberg JD. Efficacy of lumbosacral transforaminal epidural steroid injections: A systematic review. PM&R. 2009;1:657-68.
8. 8. Evans W. Intrasacral epidural injection in the treatment of sciatica. Lancet. 1930;2:1225-9.

9. 9. Rivera CE. Lumbar Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018;29(1):73-92.
10. 10. Yang G, Liao W, Shen M, Mei H. Insight into neural mechanisms underlying discogenic back pain. J Int Med Res. 2018;46(11):4427-36.
11. 11. Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. Pain Med. 2019;20(2):32-44.
12. 12. Lindblom K. Diagnostic puncture of intervertebral discs in sciatica. Acta Orthop Scand. 1948;17:231-9.
13. 13. Lindahl O, Rexed B. Histologic changes in spinal nerve roots of operated cases of sciatica - Acta Orthopaedica, 1951;20:215-25.
14. 14. Lee HM, Weinstein JN, Meller ST, et al. The role of steroids and their effects on phospholipase A2. An animal model of radiculopathy. Spine.1998;23:1191-6.
15. 15. Manchikanti L, Singh V, Pampati V, Falco FJ, Hirsch JA. Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: is one method superior to the other? Korean J Pain. 2015;28(1):11-21.
16. 16. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14:180–191.
17. 17. Karaeminoğullari O, Sahin O, Boyvat F, et al. Transforaminal epidural steroid injection under computed tomography guidance in relieving lumbosacral radicular pain. Acta Orthop Traumatol Turc. 2005;39(5):416-20.
18. 18. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002;27:11-6.
19. 19. Kim MS, Lee DG, Chang MC. Outcome of Transforaminal Epidural Steroid Injection According to Severity of Cervical Foraminal Stenosis. World Neurosurg. 2018;110:398-403.
20. 20.Olguner SK, Celiktas M, Oktay K, et al. Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain. Niger J Clin Pract. 2020;23(6):835-41.
21. 21.Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev. 2008(3):CD001824.
22. 22. Papagelopoulos PJ, Petrou HG, Triantafyllidis PG, et al. Treatment of lumbosacral radicular pain with epidural steroid injections. Orthopedics. 2001;24:145-9.
23. 23. Beyaz SG. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain. Rev Bras Anestesiol. 2017;67(1):21-7.
24. 24. Derby R. Bogduk N, Kline G. Precision percutaneous blocking procedures for localizing spinal pain. Part 2. The lumbar neurasic compartment. Pain Digest. 1993;3:175-88.
25. 25. Benny B, Azari P. The efficacy of lumbosacral transforaminal epidural steroid injections: a comprehensive literature review. J Back Musculoskelet Rehabil. 2011;24(2):67-76.
26. 26. Ploumis A, Christodoulou P, Wood KB, Varvarousis D, Sarni JL, Beris A. Caudal vs transforaminal epidural steroid injections as short-term (6 months) pain relief in lumbar spinal stenosis patients with sciatica. Pain Med. 2014;15(3):379-85.
27. 27. Manchikanti L. Transforaminal lumbar epidural steroid injections. Pain Physician. 2000; 3: 374-98.
28. 28. Kranz PG, Raduazo P, Gray L, Kilani RK, Hoang JK. CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters. AJNR Am J Neuroradiol. 2012;33(7):1221-4.
29. 29. Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10: 185-212.
30. 30. Adıgüzel E, Tecer D, Güzelküçük Ü, Taşkaynatan MA, Tan AK. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain: Combination of pain provocation with effectiveness results. Turk J Phys Med Rehabil. 2017;9:63(2):117-23.
31. 31. Atım A, Deniz S, Kılıçkaya O, Orhan M, Purtuloğlu P. Assessment of the effectiveness of lumbar transforaminal epidural steroid injection for low back pain. AGRI. 2011; 23:114-8.
32. 32. Chang A, Ng AT. Complications Associated with Lumbar Transforaminal Epidural Steroid Injections. Curr Pain Headache Rep. 2020;24(11):67.