Exact lumbar anterior epidural injection via extreme lateral approach: A novel technique and clinical outcomes

Öz

Aim: Epidural injections have become popular for relieving back and radicular pain that is persistent to conservative therapy and is being widely used as an alternative to surgery. In this retrospective clinical study, we describe a new technique for direct anterior epidural space targeting via an extreme lateral approach for epidural injection and present 1-year outcomes of the intervention. Material and Methods: In this clinical study, patients who had persistent back or radicular pain despite conventional treatment for 4 weeks were included. Anterior epidural injection via extreme lateral approach was performed in patients with degeneration of the lumbar spine, lumbar disc bulging or protrusion, and lumbar spinal stenosis. Visual Analogue Scale and Oswestry Disability Index scores were evaluated preoperatively, on postoperative 1st week, 1st month, and 12th month. Results: 186 patients were included in the study. The mean age was 48.42±11.2. 72 (38.71%) patients were male, and 114 (61.29%) patients were female. The mean duration of symptoms was 16.4±14.13 weeks. The mean VAS score for back pain preoperatively was 7.92±1.77. The postoperative VAS for back were 2.1±1.29, 2.36±2.25, and 3.11±3.25 respectively for the 1st week, 1st month, and 12nd month.The average VAS for radicular pain was 4.49±1.91 preoperatively. Postoperative VAS were 1.89±2.68, 2.32±1.08, and 2.56±1.52 respectively for the 1st week, 1st month, and 12nd month. The ODI scores were 49.76±13.59, 11.69±5.35, 12.27±7.01, 14.3±7.32 respectively preoperatively, on the postoperative 1st week, 1st month, and 12th month. Conclusion: The extreme lateral approach for anterior epidural injection is a safe and feasible technique method for the treatment of back and radicular pain.

Anahtar Kelimeler

• Anterior epidural space
• epidural injection
• low back pain
• radicular pain
• extreme lateral

Ekstrem lateral yaklaşımla gerçek lomber anterior epidural enjeksiyon: Yeni bir teknik ve klinik sonuçlar

Öz

Amaç: Epidural enjeksiyonlar, konservatif tedaviye dirençli bel ve radiküler ağrının giderilmesinde giderek daha sık kullanılan ve cerrahiye alternatif bir yöntem haline gelmiştir. Bu retrospektif klinik çalışmada, anterior epidural aralığın doğrudan hedeflenmesini sağlayan ekstrem lateral yaklaşım tekniği tanımlanmış ve 1 yıllık klinik sonuçlar sunulmuştur.. Gereç ve Yöntemler: Konservatif tedaviye rağmen 4 hafta boyunca devam eden bel veya radiküler ağrısı olan hastalar çalışmaya dahil edilmiştir. Lomber dejenerasyon, disk bulging veya protrüzyon ile lomber spinal stenozu olan olgularda aşırı lateral yaklaşım ile anterior epidural enjeksiyon uygulanmıştır. Ağrı ve fonksiyonel durum, operasyon öncesi ve operasyon sonrası 1. hafta, 1. ay ve 12. ayda Visual Analog Skoru (VAS) ve Oswestry Disability Index (ODI) ile değerlendirilmiştir. Bulgular: Çalışmaya toplam 186 hasta dahil edilmiştir. Ortalama yaş 48,4±11,2 yıl olup, 72’si (%38,7) erkek ve 114’ü (%61,3) kadındır. Ortalama semptom süresi 16,4±14,1 hafta olarak saptanmıştır. Preoperatif bel ağrısı için VAS 7,9±1,8 iken, postoperatif 1. hafta, 1. ay ve 12. ayda sırasıyla 2,1±1,3; 2,4±2,3 ve 3,1±3,3 bulunmuştur. Radiküler ağrı için VAS preoperatif 4,5±1,9 iken, 1. hafta, 1. ay ve 12. ayda sırasıyla 1,9±2,7; 2,3±1,1 ve 2,6±1,5’e gerilemiştir. ODI skorları preoperatif 49,8±13,6 iken, postoperatif 1. hafta 11,7±5,4; 1. ay 12,3±7,0 ve 12. ay 14,3±7,3 olarak kaydedilmiştir. Sonuç: Ekstrem lateral yaklaşım ile anterior epidural enjeksiyon, konservatif tedaviye dirençli bel ve radiküler ağrının tedavisinde güvenli ve uygulanabilir bir yöntem olup, kısa ve orta dönemde anlamlı klinik iyileşme sağlamaktadır.

Anahtar Kelimeler

• Anterior epidural boşluk
• epidural enjeksiyon
• bel ağrısı
• radiküler ağrı
• ekstrem lateral

Kaynakça

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