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The comparsion between steroid and hypertonic saline 10% with steroid in transforaminal epidural injection in patients with unilateral foraminal stenosis

Behnam Hosseini, Mohammad Hossein Ataei, Sirous Momenzadeh, Reza Jalili khoshnood, Davood Ommi
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Abstract

Introduction: Chronic radicular low back pain is a common disease that limits patient’s daily activity. Epidural steroid injection (ESI) is becoming the mainstay of therapies for radicular low back pain due to contained bulged disc.

Aim: To determine the effect of adding hypertonic saline to epidural steroid injections to provide pain relief for chronic radiculopathy back pain secondary to foraminal stenosis.

Method: In a randomized clinical trial, 50 patients with unilateral radicular low back pain due to unilateral foraminal stenosis were enrolled. Epidural steroid injections were performed using transforminal approach. In hypertonic saline group 80 mg of triamcinolone plus 2 ml of 10% hypertonic saline, and in control group 80 mg of triamcinolone plus 2 ml of normal saline were injected. Outcome measures were numerical rating scale (NRS), Oswestry disability index (ODI), and proportion of responder patients (NRS<3) were measured at baseline, 1, 3, and 6 months post-procedure.

Results: Comparison of pain score between two groups showed that pain score was not significantly different at 1(p=0.24), 3 (p=0.31) and 6 (p=0.38) month. significant pain relief (NRS<3) in 76% of patients within 1 months. Percent of patient with NRS<3 was 48% and 32% in hypertonic and 40% and 32% in steroid group at 3 and 6 month respectively.

Conclusion: hypertonic saline added to steroid did not significantly increase pain relief effect of epidural steroid injection.


References

Tarulli Aw,Raynor EM.Lumbosacral radiculopathy.Neuro clin.2007;25:387-405.

Park HJ, Kim SS, Lee SY, Park NH, Rho MH, Hong HP, Kwag HJ, Kook SH, Choi SH. Clinical correlation of a new MR imaging method for assessing lumbar foraminal stenosis. AJNR Am J Neuroradiol 2012; 33:818-822.

Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976) 2000; 25:389-394.

Govind J:Lumbar radicular pain .Aust Fam Physcian,2004;33:409-412.

Turner JA, Ersek M, Herron L, Deyo R.Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976). 1992 Jan;17(1):1-8.

Benzon HT:Epidural steroid hnjections for low back pain and lumbosacral radiculopathy.Pain 1986;24:277-295

Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, et al. Evidence-based practice guidelines for interventional techniques in the management of chronicspinal pain.Pain Physician. 2003 Jan;6(1):3-81.

Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, Slaten WK, Rao S. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 2002; 81:898-905.

Ghai B, Bansal D, Kay JP, Vadaje KS, Wig J. Transforaminal versus parasagittal interlaminar epidural steroid injection in low back pain with radicular pain: a randomized, double-blind, active-control trial. Pain Physician. 2014 Jul-Aug;17(4):277-90.

Koh wu, choi ss, park sy, et al. Transforaminal hypertonic saline for treatment of lumbar lateral canal stenosis;Pain physcian .2013;16(3):197-211

Boswell MV, Hansen HC, Trescot AM, Hirsch JA.Epidural steroids in the management of chronic spinal pain and radiculopathy. Pain Physician. 2003 Jul;6(3):319-34.

Jenis LG, An HS.Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976). 2000 Feb 1;25(3):389-94.

Ghahreman A, Bogduk N.Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Med. 2011 Jun;12(6):871-9.

Helm Ii S, Benyamin RM, Chopra P, Deer TR, Justiz R. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain Physician. 2012 Jul-Aug;15(4):E435-62.

Iversen T, Solberg TK, Romner B, Wilsgaard T, Twisk J, Anke A, Nygaard O, Hasvold T, Ingebrigtsen T. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: Multicentre, blinded, randomised controlled trial. BMJ 2011; 343:d5278.

Yousef AA, EL-Deen AS, Al-Deeb AE.The role of adding hyaluronidase to fluoroscopically guided caudal steroid and hypertonic saline injection in patients with failed back surgery syndrome: a prospective, double-blinded, randomized study.

Pain Pract. 2010 Nov-Dec;10(6):548-53.

Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural lysis of adhesions.Korean J Pain. 2014 Jan;27(1):3-15.

Jamison DE, Hsu E, Cohen SP. Epidural adhesiolysis: an evidence-based review. J Neurosurg Sci. 2014 Jun;58(2):65-76.

Manchikanti L, Cash KA, McManus CD, Pampati V.Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. Int J Med Sci. 2013; 10(1):50-9.

Chou R,Atlas Sj,Stanos Sp,et al.Non surgical interventional therapies for low back pain . Spine 2009 May 1;34(10):1078-93




DOI: https://doi.org/10.22037/icnj.v2i2.8771

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