超声引导下尾硬膜外注射治疗腰椎管狭窄症症状:一项回顾性研究。

IF 1.8 Q3 MEDICINE, RESEARCH & EXPERIMENTAL European Journal of Translational Myology Pub Date : 2024-05-07 DOI:10.4081/ejtm.2024.12167
Veronica Gagliardi, Antonello Lovato, Francesco Ceccherelli, Giuseppe Gagliardi
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引用次数: 0

摘要

腰椎管狭窄症(LSS)是指下轴脊柱的骨质、韧带和滑膜成分发生退行性变和过度生长,压迫椎管内的神经和血管成分。压迫可导致静态背痛、下肢根性疼痛或神经源性跛行。诊断腰椎管狭窄需要放射学和临床发现。在这种情况下,尾侧硬膜外类固醇注射(ESI)是一种标准治疗方法。注射量和针头位置是影响硬膜外注射效果的主要问题。不过,近年来超声引导下的硬膜外腔注射越来越普遍。自 Klocke 及其同事于 2003 年描述了超声引导下的尾椎阻滞后,这种方法越来越受欢迎。多个种族的研究报告显示,超声引导下的尾椎注射成功率高达 96.9%-100%。彩色多普勒超声也能确定药液是否到达腰骶部。我们招募了 42 名患有腰椎管狭窄症、顽固性腰痛和对止痛药无反应的神经源性跛行且不适合手术治疗的患者。每位患者每周接受四次注射,为期四周。如果患者对治疗有反应但仍有疼痛,则需要每月注射一次以达到并维持疗效。如果患者在接受 4 次尾硬膜外注射后仍无反应,则将改变治疗方法。无菌尾部硬膜外注射是在超声波引导下用 21G 的脊柱针进行的。注射剂量为曲安奈德 40 毫克、左旋布比卡因 10 毫克和生理溶液 10 毫升。每位患者平均接受 4 次注射治疗(4±2,平均数 4,标差 2)。数据分析显示,治疗前后疼痛明显减轻,3 个月后疼痛仍持续。尾硬膜外注射是治疗慢性腰背痛伴根底病变最常见的保守疗法之一,利多卡因单独或与类固醇一起使用效果显著。在此框架下,文献中关于硬膜外腔注射对腰痛疗效的两个主要问题是正确的。因此,10 毫升的剂量对于治疗症状是合适和有效的,且无副作用。从开始到结束,疼痛减轻超过 50%,三个月的随访显示,疼痛控制和残疾改善效果显著。最后,尾部硬膜外注射治疗腰椎管狭窄症症状有效、安全,并能长期缓解疼痛。
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Ultrasound-guided caudal epidural injection to treat symptoms of lumbar spinal stenosis: a retrospective study.

Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief.

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来源期刊
European Journal of Translational Myology
European Journal of Translational Myology MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
3.30
自引率
27.30%
发文量
74
审稿时长
10 weeks
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