背景:硬膜外类固醇注射(ESI)涉及将类固醇和局部麻醉药注入脊髓硬膜外腔,它们是通过在黄韧带和硬脑膜之间插入针来进行的。此手术适用于继发于椎间盘突出或术后神经根疼痛的腰骶神经根病患者。镇痛药物的缓解期可能会延长>6周,导致非手术治疗成为一个合适的选择。然而,已经报道了ESI对骨矿物质密度的负面影响。
目的:我们旨在通过分析全国人群数据库来阐明ESI与骨质疏松症风险之间的关联。
方法:本研究是一项全国性的回顾性队列研究。
方法:收集了从国家健康保险研究数据库(NHIRD)的2000年受益人注册中随机选择的100万例病例的数据。
方法:总共,从NHIRD中确定了4,957名在2000年至2013年之间被诊断为腰椎疾病并接受ESI的患者。随后,另外4957例腰椎病患者从相同的数据库中随机选择,并按年龄匹配频率,性别,以及接受ESI的患者的指数年份。
结果:患者的平均年龄为50.3±17.1岁。ESI和非ESI组的骨质疏松症发生率分别为7.95和7.01/1000人年,分别。ESI队列中骨质疏松风险显著高于非ESI队列(绝对标准化风险比=1.23,95%置信区间=1.05-1.45,P=0.01)。骨质疏松的危险因素为高龄,作为女性,正在经历ESI。ESI队列中的骨质疏松风险显著高于非ESI队列中的男性,最低城市化水平(第四水平),其他职业,和无合并症的亚组。
结论:NHIRD没有提供骨质疏松症相关量表的信息,肾功能,血压,吸烟习惯,肺功能,日常活动,注射类固醇的剂量。
结论:对于被诊断为腰椎病的患者,ESI与高骨质疏松症风险相关。因此,这种疗法应该谨慎推荐,特别是对于具有相关危险因素的患者(例如,骨质疏松性骨折的高风险,社会经济地位低下,和退休或失业状态)。
Epidural steroid injections (ESIs) involve the administration of steroids and local anesthetics into the spinal epidural space, and they are performed by inserting a needle between the ligamentum flavum and dura. This procedure is suitable for patients with lumbosacral radiculopathy secondary to disc herniation or postsurgical radicular pain. The relief period of the analgesic medications may be prolonged by > 6 weeks, resulting in nonsurgical management becoming a suitable option. However, the negative effect of ESIs on bone mineral density has been reported.
We aimed to clarify the association between ESIs and osteoporosis risk by analyzing a nationwide population database.
This
study is a nationwide retrospective cohort
study.
Data on 1 million cases randomly selected from the 2000 Registry for Beneficiaries of the National Health Insurance Research Database (NHIRD) were collected.
In total, 4,957 patients who were diagnosed with lumbar spondylosis and received ESIs between 2000 and 2013 were identified from the NHIRD. Subsequently, another 4,957 patients with lumbar spondylosis were randomly selected from the same database and frequency matched by age, gender, and index year with the patients who received ESIs.
The mean age of the patients were 50.3 ± 17.1 years. The incident rates of osteoporosis in the ESI and non-ESI groups were 7.95 and 7.01 per 1,000 person-years, respectively. Osteoporosis risk was significantly higher in the ESI cohort than in the non-ESI cohort (absolute standardized hazard ratio = 1.23, 95% confidence interval = 1.05-1.45, P = 0.01). The risk factors for osteoporosis were old age, being female, and undergoing ESIs. Osteoporosis risk was significantly higher in the ESI cohort than in the non-ESI cohort in the male, lowest-urbanization-level (fourth level), other-occupations, and comorbidity-free subgroups.
The NHIRD did not provide information on osteoporosis-related scales, renal function, blood pressure, smoking habit, pulmonary function, daily activities, and dosage of injected steroids.
For patients diagnosed with lumbar spondylosis, ESIs are associated with a high osteoporosis risk. Thus, this therapy should be recommended with caution, especially for patients with correlated risk factors (e.g., high risk of osteoporotic fracture, low socioeconomic status, and retired or unemployed status).