背景:颗粒类固醇被认为在注射部位长时间发挥作用。然而,当用于硬膜外类固醇注射时,这些类型的类固醇具有更高的风险。灾难性脊髓并发症,包括突然发作的截瘫,据报道,由于血管内颗粒类固醇制剂引起血管栓塞和闭塞,导致脊髓梗塞.临床医生,因此,推荐非颗粒类固醇来减轻这些不良事件.据我们所知,这是首次针对甲基强的松龙的有效性和安全性的回顾性研究,地塞米松,和倍他米松用于经椎间孔硬膜外类固醇注射(TFESI)治疗腰椎神经根病。
目的:本研究的主要目的是比较在初次注射后12个月内接受颗粒类固醇注射并需要零重复注射的患者比例与接受非颗粒类固醇注射并需要零重复注射的患者比例。以及比较微粒队列中在初次注射后12个月内需要一次或多次重复注射的患者人数与非微粒队列中需要一次或多次重复注射的患者人数。次要目标是评估最终需要手术的患者比例。
方法:这是一个单中心,IRB批准,回顾性研究评估了非颗粒类固醇药物与颗粒类固醇药物在TFESI中作为慢性腰椎神经根病的微创治疗时的安全性和有效性。
方法:本研究收集了4年时间范围内(2018年1月15日至2022年1月15日)的数据(n=1717)。
方法:从每个患者的图表中收集以下数据:年龄,性别,BMI,种族,初次注射的日期,在初次注射的12个月内,在相同的腰骶水平和同一侧重复注射的次数,和腰椎手术日期(如适用)。纳入标准包括:1)具有神经根病因的慢性下腰痛;2)至少18岁;3)在12周后经历过保守治疗失败(包括物理治疗和/或药物治疗);4)具有支持神经撞击的积极体格检查结果(直腿抬高,坍落度测试);5)显示腰椎间盘突出症神经撞击的腰椎MRI证据。排除标准包括:1)先前接受过任何水平的腰椎手术(L1-S1);2)在初次注射前不到6个月接受过TFESI;3)在拟议的注射部位感染了全身性感染;4)接受了积极的癌症治疗;5)接受了任何其他脊柱注射。
结果:非颗粒类固醇队列中接受0次重复注射的患者比例明显更高(87.5%vs71.4%,P<0.001)。颗粒类固醇队列显示在初次注射后12个月内接受重复注射的患者比例明显更高(12.5%vs29.6%,P<0.001)。两组之间需要手术的患者之间没有显着差异。其他结果指标包括识别与重复注射显著相关的危险因素。年龄与重复注射之间存在统计学上的弱正相关(Pearsoncorr=0.102;P<0.001),种族/种族与重复注射之间存在弱负相关(双点corr=-0.093;P<0.001)。未报告不良事件。
结论:本研究中并非所有临床医生都使用了3种类固醇类型中的每一种,所有临床医生都只使用微粒或非微粒类固醇。
结论:我们的研究表明,当使用两种药物治疗腰椎神经根病时,与非颗粒类固醇的TFESI相关的临床结果优于与颗粒类固醇的TFESI相关的临床结果。这是第一项使用侧向性信息的临床有用预测模型的研究,年龄,和类固醇类型。
BACKGROUND: Particulate steroids are thought to exert their effects for long durations at injection sites. However, these types of steroids carry higher risks when used in epidural steroid injections. Catastrophic spinal cord complications, including sudden-onset paraplegia, have been reported due to intravascular particulate steroid preparations that cause embolisms and occlusion of blood vessels, resulting in spinal cord infarctions. Clinicians, therefore, recommend nonparticulate steroids to mitigate these adverse events. To our knowledge, this is the first retrospective study that addresses the effectiveness and safety of methylprednisolone, dexamethasone, and
betamethasone when used in transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar radiculopathy.
OBJECTIVE: The primary goal of this study was to compare the proportion of patients who received injections of particulate steroids and required zero repeat injections within 12 months of their initial injection to the proportion of patients who received injections of nonparticulate steroids and also required zero repeat injections, as well as to compare the number of patients in the particulate cohort who required one or more repeat injections within 12 months of their initial injection to the number of patients in the nonparticulate cohort who required the same. The secondary goal was to evaluate the proportion of patients ultimately requiring surgery.
METHODS: This is a single-center, IRB-approved, retrospective study evaluating the safety and effectiveness of nonparticulate as compared to particulate steroid medications when used in TFESIs as minimally invasive treatments for chronic lumbar radiculopathy.
METHODS: This study captured data (n = 1717) over a 4-year time frame (01/15/2018 to 01/15/2022).
METHODS: The following data were collected from each patient\'s chart: age, gender, BMI, race, date of initial injection, number of repeat injections at the same lumbosacral level and on the same side within 12 months of the initial injection, and lumbar surgery date (if applicable). Inclusion criteria included: 1) having chronic low back pain of radicular etiology; 2) being at least 18 years old; 3) having experienced the failure of conservative therapy after 12 weeks (including physical therapy and/or medications); 4) having positive physical exam findings supporting nerve impingement (straight leg raise, slump test); and 5) showing lumbar MRI evidence of nerve impingement from disc herniation. Exclusion criteria included: 1) having received prior lumbar surgery at any level (L1-S1); 2) having been given prior TFESIs fewer than 6 months prior to initial injection; 3) having contracted a systemic infection at the proposed injection site; 4) undergoing active cancer treatment; and 5) having gotten any other spine injections.
RESULTS: A significantly greater proportion of patients in the nonparticulate steroid cohort received 0 repeat injections (87.5% vs 71.4%, P < 0.001). The particulate steroid cohort demonstrated a significantly greater proportion of patients who received repeat injections within 12 months after the initial injections (12.5% vs 29.6%, P < 0.001). There were no significant differences among patients requiring surgery between the 2 cohorts. Other outcome measures included the identification of risk factors significantly associated with repeat injections. There was a statistically significant weak positive correlation between age and repeat injections (Pearson corr = 0.102; P < 0.001) and a weak negative correlation between ethnicity/race and repeat injections (point-biserial corr = -0.093; P < 0.001). No adverse events were reported.
CONCLUSIONS: Not all clinicians included in this study used each of the 3 steroid types, and all clinicians used either particulate or nonparticulate steroids exclusively.
CONCLUSIONS: Our study demonstrates that the clinical outcomes associated with TFESIs of nonparticulate steroids are superior to those associated with TFESIs of particulate steroids when either variety of medication is used to treat lumbar radiculopathy. This is the first study to include a clinically useful predictive model using information on laterality, age, and steroid type.