Experience with the use of caudal epidural blockades in treatment of pain syndromes of the lumbosacral spine

April 8, 2019
1346
Resume

Caudal epidural blockade (CEB) is a minimally invasive method for the treatment of pain in the lumbosacral spine. CEB in treatment of vertebral pain syndrome is becoming increasingly popular due to its high efficiency and low risk of complications. The purpose of the study is to evaluate the effectiveness of the technique of CEB under fluoroscopic control in treatment of pain in the lumbosacral spine in its dege­nerative-dystrophic lesion. Material and methods. A retrospective analysis of the results of treatment of 92 patients (45 men, 47 women) aged 52±4 years was carried out with complaints of pain in the lumbosacral spine against the background of degenerative-dystrophic diseases of the spine, which was carried out by CEB: 51 patients with protrusions or herniated intervertebral discs (group 1) and 41 patients with lumbar spinal stenosis (group 2). The observation period was at least 3 months after the procedure. Evaluation of the results of treatment was carried out on visual analog scale (VAS) and the Roland — Morris and Oswestry Disability Index (ODI). Results. After the use of CEB positive results were achieved in 54% of patients with protrusions or herniated intervertebral discs and 49% with stenosis. The regression of pain syndrome according to VAS correlated with the improvement of the quality of life according to the data of the Roland — Morris and ODI questionnaires at all stages of observation (rcan=0.82–0.91–0.93–0.94; p<0.05). Conclusions. CEB is an effective method for the treatment of pain in the lumbosacral spine with hernias and intervertebral disc protrusions, as well as lumbar spinal stenosis during 3 months after the procedure.

Published: 08.04.2019

References:

  • Bublik L.A., Stegnij S.A., Titov J. et al. (2006) Epidural blockades with pronounced root and pain syndrome caused by the pathology of the intervertebral discs of the lumbar spine, with the use of Xefakam and lidocaine. Interreg. Neurologic. J., 1(5): 62–64.
  • Datta R., Upadhyay K.K. (2011) A Randomized Clinical Trial of Three Different Steroid Agents for Treatment of Low Backache through the Caudal Route. Med. J. Armed Forces India, 67(1): 25–33.
  • Gaskin D.J., Richard P. (2012) The economic costs of pain in the United States. J. Pain, 13(8): 715–724.
  • Hirabayashi K., Miyakawa J., Satomi K. (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine, 6: 354–364.
  • Huda N., Bansal P., Gupta S.M. et al. (2010) The efficacy of epidural depo-methylprednisolone and triamcinolone acetate in relieving the symptoms of lumbar canal stenosis: a comparative study. J. Clin. Diagn. Res., 4: 2842–2847.
  • Kremer Yu. (2013) Intervertebral disc diseases (пер. с англ. В.A. Широкова (ред.)). МЕДпресс-информ, Москва.
  • Manchikanti L., Cash K.A., McManus C.D. et al. (2012) Results of 2-year follow-up of a randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in central spinal stenosis. Pain Physician, 15(5): 371–384.
  • Manchikanti L., Singh V., Cash K.A. et al. (2012) Effect of fluoroscopically guided caudal epidural steroid or local anesthetic injections in the treatment of lumbar disc herniation and radiculitis: a randomized, controlled, double blind trial with a two-year follow-up. Pain Physician, 15(4): 273–286.
  • Murakibhavi V.G., Khemka A.G. (2011) Caudal epidural steroid injection: a randomized controlled trial. Evid. Based Spine Care J., 2(4): 19–26.
  • Prodan A.I., Perepechaj O.A., Kolesnichenko V.A. (2009a) Conservative treatment of lumbar spinal stenosis: current trends, concepts and methods. J. Neurosci. Psychiatr. named after S. Korsakov, 7: 92–95.
  • Prodan A.I., Popsujshapka K.A., Kolesnichenko V.A. (2005) Errors and complications in epidural treatment and diagnostic blockades. Orthoped. Traumatol. Prosthet., 4: 113–117.
  • Prodan A.I., Radchenko V.A., Korzh N.A. (2009b) Degenerative diseases of the spine. Contrast, Kharkov, 262 р.
  • Radchenko V.A. (2000) Therapeutic blockade with the use of corticosteroids in degenerative-dystrophic diseases of the lumbar spine. Orthoped. Traumatol. Prosthet., 3: 116–121.
  • Sayegh F.E., Kenanidis E.I., Papavasiliou K.A. et al. (2009) Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine (Phila Pa 1976), 34(14): 1441–1447.
  • Standring S. (2014) Gray’s Anatomy: the Anatomical basis of clinical practice: 50 anniversary edition. 40th ed. 1576 p.