Effect of Interlaminar Epidural Steroid Injection in Acute and Subacute Pain Due to Lumbar Disk Herniation: A Randomized Comparison of 2 Different Protocols
I.D. Gelalis*, 1, E. Arnaoutoglou2, E.E. Pakos1, A.N. Politis1, M. Rapti2, T.A. Xenakis1, G. Papadopoulos2
1 Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
2 Department of Anesthesiology, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up.
Keywords: Low back pain, radicular pain, lumbar spine, disk herniation, epidural injections.
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* Address correspondence to this author at the Department of Orthopaedic Surgery, University of Ioannina, Medical School, Ioannina, 45100, Greece; Tel: +302651043892; Fax: +302651097891; E-mail: firstname.lastname@example.org