Volume 7 | Issue 1 | Jan – April 2019 | Page: 19-23 | Sreedhara K Doddery, Nishanth Ampar.
Authors: Sreedhara K Doddery , Nishanth Ampar .
 Department of Orthopaedics, Prime Medical Centre, Bur Dubai, Dubai
 Department of Orthopaedics, Kasturba Medical College, Manipal-Manipal Academy of Higher Education
Address of Correspondence
Department of Orthopaedics
Kasturba Medical College,Manipal-MAHE
Introduction: Low back pain with or without radicular pain is a common problem with a significant impact on the economic and health status of patients. Various treatment modalities are in use with variable outcome. Epidural injections are one of the most commonly performed interventions to provide early pain relief for low backache with radicular pain. However, the evidence is highly variable with regard to the outcome following the interlaminar epidural steroid injections.
Aim: This study was undertaken to assess the efficacy of epidural steroid injection for providing pain relief in cases of low backache with radiculopathy, due to intervertebral disc prolapse prolapsed intervertebral disc (PID) and canal stenosis.
Methods: Among 77 patients, 69 patients completed the follow-up and were included in the final analysis (48 in PID group and 21 in canal stenosis group). Verbal numeric rating scale (VNRS) and Modified North American Spine Society (NASS) patient satisfaction scores were among the parameters used to evaluate the patients.
Results: The patients from both the groups demonstrated significant improvement in post-injection VNRS scores and showed very good satisfaction based on the NASS patient satisfaction scores, with favorable outcome in terms of pain relief.
Conclusions: Interlaminar lumbar epidural steroid injection is a useful, effective, and safe treatment modality for low back pain with radiculopathy due to lumbar intervertebral disc prolapse and/or canal stenosis.
Keywords: Epidural steroid injection, intervertebral disc prolapse, lumbar canal stenosis.
1. Stafford MA, Peng P, Hill DA. Sciatica: A review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 2007;99:461-73.
2. Onozawa T, Atsuta Y, Sato M, Ikawa M, Tsunekawa H, Feng X, et al. Nitric oxide induced ectopic firing in a lumbar nerve root with cauda equina compression. Clin Orthop Relat Res 2003;408:167-73.
3. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934;211:2105.
4. Lindahl O, Rexed B. Histologic changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand 1951;20:21525.
5. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebocontrolled trial evaluating the effect of piroxicam. Spine (Phila PA 1976) 1993;18:1433-8.
6. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am 2010;21:825-34.
7. Pandey RA. Efficacy of epidural steroid injection in management of lumbar prolapsed intervertebral disc: A Comparison of caudal, transforaminal and interlaminar routes. J Clin Diagn Res 2016;10:RC05-11.
8. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-24.
9. Rezende R, Jacob Júnior C, da Silva CK, de Barcellos Zanon I, Cardoso IM, Batista Júnior JL, et al. Comparison of the efficacy of transforaminal and interlaminar radicular block techniques for treating lumbar disk hernia. Rev Bras Ortop 2015;50:220-5.
10. Beyaz SG. Comparison of transforaminal and interlaminarepidural steroid injections for the treatment of chronic lumbar pain. Rev Bras Anestesiol 2017;67:21-7.
11. Paisley K, Jeffries J, Monroe M, Choma T. Dispersal pattern of injectate after lumbar interlaminar epidural spinal injection evaluated with computerized tomography. Global Spine J 2012;2:27-32.
12. Rabinovitch DL, Peliowski A, Furlan AD. Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain. Spine J 2009;9:509-17.
13. Ackerman WE 3rd, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007;104:1217-22, tables of contents.
14. Botwin K, Brown LA, Fishman M, Rao S. Fluoroscopically guided caudal epidural steroid injections in degenerative lumbar spine stenosis. Pain Physician 2007;10:547-58.
15. Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 1998;14:148-51.
16. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11-21.
17. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: A review of the evidence for an American pain society clinical practice guideline. Spine (Phila PA 1976) 2009;34:1078-93.
18. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med 2011;12:726-31.
19. Wybier M, Gaudart S, Petrover D, Houdart E, Laredo JD. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol 2010;20:181-9.
20. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 1988;27:295-9.
|How to Cite this article: Doddery SK, Ampar N. Interlaminar Lumbar Epidural Steroid Injections for Pain Relief in Cases of Low Backache due to Disc Prolapse and Canal Stenosis. Journal of Karnataka Orthopaedic Association. Jan-April 2019; 7(1): 19-23.