Treatment of degenerative chronic low back pain with fluoroscopically guided epidural procaine-corticosteroid injection

Abstract

Background/Aim. Low back pain is one of the most common painful conditions in the modern age. Therefore, it is very important to establish the most effective protocol for the treatment of this condition. The aim of this study was to find out if fluoroscopically, guided epidural procainecorticosteroid injection is effective in the treatment of degenerative chronic low back pain. Methods. This prospective cohort study was performed in the Military Medical Academy from September 2005 to June 2006 and included 60 patients of both sexes, 34-85 years of age. Degenerative changes of lumbosacral spine were determined by magnetic resonance imaging. The intensity of low back pain was evaluated by subjective (Roland's scale) and objective parameter (Lazarevic sign). Epidural procaine-corticosteroid injection was applied in the patients with low back pain not responding to conservative therapy. After the application of injection, effects of the therapy were followed up. Results. In 92% of the patients there was a reduction of pain intensity for three months, in 4.8% a reduction for a month, but after another injection they felt pain reduction for the next three months. One patient (2.3%) had pain reduction for one month. Conclusion. In the treatment of degenerative chronic low back pain, not responding to conservative therapy with nonsteroidal anti-inflammatory drugs, epidural procaine-corticosteroid injection have a satisfactory short-term as well as a long-term analgesic effect.Uvod/Cilj. Bol u lumbosakralnom predelu predstavlja jednu od najcescih bolnih manifestacija savremenog coveka. Zbog toga je veoma vazno naci sto efikasniji algoritam lecenja ovog bolnog stanja. Cilj ovog rada bio je da se utvrdi znacaj fluoroskopski vodjene epiduralne injekcije kombinacije prokainkortikosteroid u kontroli hronicnog lumbosakralnog bola degenerativne geneze. Metode. Prospektivnom kohortnom studijom sprovedenoj u Vojnomedicinskoj akademiji, u periodu od septembra 2005. do juna 2006. godine, obuhvaceno je 60 bolesnika oba pola, starosti 34-85 godina. Degenerativne promene lumbosakralnog dela kicmenog stuba ustanovljene su primenom magnetne rezonancije. Intenzitet bola je odredjen na osnovu subjektivnog parametra (Rolandova skala), kao i objektivnog parametra (Lazarevicev znak). Nakon neuspesne konzervativne medikamentne terapije data je epiduralna injekcija kombinacije prokain-kortikosteroid (EPSI) sakralnim putem. Efekat terapije pracen je neposredno nakon primljene injekcije, petog dana (kratkorocni efekat) i u periodu posle mesec i nakon tri meseca (dugorocni efekat). Rezultati. Kod 92% bolesnika doslo do smanjenja bola tokom tri meseca, kod 4,8% smanjenje bola trajalo je jedan mesec, ali su posle druge injekcije i oni imali smanjenje bola tri meseca, dok je jedan bolesnik (2,3%) imao smanjenje bola tokom mesec dana. Zakljucak. U lecenju hronicnog lumbalnog bola degenerativnog porekla kod kojeg je konzervativna terapija nesteroidnim antiinflamatornim lekovima bez efekta, primena EPSI obezbedjuje zadovoljavajuci i kratkorocni i dugorocni analgetski efekat.