EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

ISSN: Active
eISSN: 3023-6738
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
The efficacy of lumbar epidural steroid injections in “failed back surgery syndrome” and lumbar radiculopathy
Abstract
Aims: Lumbago is one of the common conditions in our present community. Definite periods of human’s life people encountered in the form of usually regressing attacks that %10-%15 of this important condition requires surgical therapy. Cause of wrong diagnosis and treatment Spinal surgery may not always give favourable result. Patients undergone one or more back surgery exist back and/or leg pain which does not improve, is called failed back surgery syndrome. Epidural steroid administration is one of the most invasive method which is used in back pain. Effects and application results are controversial. In this study we aimed to compare the effects of steroid and local anesthetic solutions which administered by epidural way on pain controlling between the patients that have chronic back pain because of lomber radiculopathy, undergone surgery and not surgery.
Methods: It was evaluated retrospectively pain controlling effect of administered steroid and local anesthetics by interlaminal epidural way to ASA 1-2-3, between 18-80 aged 40 patient which undergone piror one or plural back surgery and have no surgery between May 2009-December 2009 apply with back pain complaint to İstanbul Education and Research Hospital Algology Department. Patient’s visuel analog scala (VAS) and severity of back pains, before procedure, second week after procedure, fourth week after procedure, sixth week after procedure in either two groups out of ten points was estimated.
Results: Totally of 7 ml solution which contains 1 ml triamsinolon asetonid 40 mg/ml (Sinakort-A ampul, İ.E. Ulugay), 3 ml levobupivacaine 5mg/ml ( Chirocaine ampul, Abbott) and 3 ml serum phsiyologic ( % 0,9 NaCl ) administered by epidural way into either two group patients. There were no significant difference between two groups by mean of age, weight, height, BMI and back pain durations. Evaluating the groups into themselves, opioid requirements and VAS scores before injection was markedly higher than 2,4 and 6. week scores in either two groups (p<0.05). There was no statistically significant difference when we compare into groups of 2,4 and 6. week opioid requirements and VAS scores in either two groups. All patient manifested their pleasure and there was no complication occured.
Conclusion: Consequently; it was thought that epidural administration of steroid (triamsinolon) ,local anesthetics (levobupivacaine) and serum physiologic solution was effective especially on early back pain treatment, also safe method and beneficial to patient satisfaction in the patients who has failed back surgery and chronic back pain.

Keywords : Radicolopaty, pain, steroid

Download Article


1. Mekanik bel ağrısı. In: Erdine S. Ağrı. 3rd ed. Nobel Tıp Kitap Evi:2007:425.
2. Bel ağrılarında multidisipliner yaklaşım. In: Erdine S. Ağrı. 3rd ed.Nobel Tıp Kitap Evi: 2007:423.
3. Block AR. Psychological screening of spine surgery candidates. In:Hoschschuler SH, Cotler HB, Guyer RD, eds. Rehabilitation of TheSpine. Science and Practice. Mosby: 1993:617-625.
4. Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults.Clinical Practice Guideline No. 14. AHCPR Public Health Service, USDepartment of Health and Human Services, 1994.
5. Coşar A. Başarısız bel cerrahisi sendromu. J Spin Surg. 2009;20(2):89-94.
6. Ergin A. Bel ağrılarında epidural steroid uygulamaları. Ağrı.2005;17(1):23-27.
7. G&ouml;zdemir M, Sert H, Usta B, Demircioğlu RI. Epidural steroidenjeksiyonu. Yeni Tıp Derg. 2007;24:17-22.
8. Lee JH, An JH, Lee SH, Comparison of effectiveness of interlaminarand bilateral transforaminal epidural steroid injections in treatmentof patients with lumbosacral disc herniation and spinal stenosis. Clin JPain. 2009;25(3):206-210.
9. Marshall LL, Trethewie ER, Curtain CC. Chemical radiculitis: aclinical, physiological, and imunological study. Clinical Ortop RelatRes. 1977;129:61-67.
10. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epiduralsteroid injections in lumbosacral radiculopathy: a prospectiverandomized study. Spine. 2002;27(1):11-16.
11. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbarsteroids: an outcome study. Arch Phys Med Rehabil. 1998;79(11):1362-1366.
12. Saal JA, Saal JS, Herzog RJ. The natural history of lumbar intervertebraldisc extrusion treated nonopratively. Spine. 1990;15(7):683-686.
13. Onda A, Yabuki S, Kikuchi S, Satoh K, Myers RR. Effects of lidocaineon blood flow and endoneurial fluid pressure in a rat model of herniatednucleus pulposus. Spine. 2001;26(20):2186-2191.
14. Pirbudak L, Karakurum G, Şatana T, et al. Disk hernisi kaynaklı akutdiskojenik bel ağrılarında epidural steroid enjeksiyonu ve amitriptilinkullanımı. Joint Dis Relat Surg. 2003;14(2):89-93.
15. Aldemir T. Epidural steroid injeksiyonu. In: Erdine S. Ağrı. 2nd ed.Nobel Tıp Kitabevi: 2002: 644-650.
16. Warr AC, Wilkinson JA, Burn JM, Langdon L. Chronic lumbosciaticsyndrome treated by epidural injection and manipulation. Practitioner.1972;209(249):53-59.
17. Dvorak J, Valach L, Fuhrimann P, Heim E. The outcome of surgery forlumbar disc herniation. II. a 4-17 years&rsquo; follow-up with emphasis onpsychosocial aspects. Spine. 1988;13(12):1418-1422.
18. Nachemson AL. Evaluation of results in lumbar spine surgery. ActaOrthop Scand. 1993;251:130-133.
19. Gabriel EM, Friedman AH. The Failed Back Surgery Syndrome.In: Wilkins RH, Rengachary SS, eds. Neurosurgery Vol. 3. 2nd ed.Mcgraw-Hill: 1995:3863-3870.
20. Guo HR, Tanaka S, Halperin WE, et al. Back pain prevalence inUS industry and estimates of lost work days. Am J Public Health.1999;89(7):1029-1035.
21. Devulder J. Transforaminal nerve root sleeve injection withcorticosteroids, hyaluronidase, and local anesthetic in the failed backsurgery syndrome. J Spinal Disord. 1998;11(2):151-154.
22. Devulder J, Deene P. Nerve root sleeve injections in patients with failedback surgery syndrome: a comparison of tree solutions. Clin J Pain.1999;15(2):132-135.
23. Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroidinjections for sciatica due to herniated nucleus pulposus. New Eng JMed. 1997;336(23):1634-1640.
24. Buchner M, Zeifang F, Brocai DR, Schiltenwolf M.Epiduralcorticosteroid injection in the conservative managementofsciatica. Clin Orthop. 2000;375:149-156.
25. Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatoryphospholipase A2 activity in lumbar disc herniations. Spine.1990;15(7):674-678.
26. Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injectionson the need for operative treatment of lumbar radicular pain. Aprospective, randomized, controlled, double-blind study. J Bone JointSurg. 2000;82(11):1589-1593.
Article available in :
Volume 1, Issue 2, 2024
Page : 24-28
https://doi.org/10.51271/EAJAIC-0006
Article Information
Received : 04 Oca 2024
Accepted : 07 Mar 2024
Published : 16 May 2024
Corresponding Author :

Semih Aydemir: Department of Anesthesiology and Reanimation, Ankara Atatürk Sanatorium Training and Research Hospital, University of Health Sciences, Ankara, Turkiye

[email protected]
Citation : Sevim S, Aydemir S, Tozan EN. The efficacy of lumbar epidural steroid injections in “failed back surgery syndrome” and lumbar radiculopathy. Eur J Anesthesiol Intensive Care. 2024;1(2):24-28.

Read: 27
Cited: 0
Download : 65
_Footer