背景:经椎间孔硬膜外类固醇注射(TFESI)通常用于治疗腰骶部神经根病。尽管具有抗炎特性,尚未研究添加3%高渗盐水。
目的:比较添加0.9%NaCl(N组)与添加NaCl的效果TFESI中3%NaCl(H组)用于腰骶神经根病。
方法:这项回顾性研究比较了使用利多卡因进行的TFESI,曲安奈德和0.9%NaCl。主要结果是3个月时口头评定量表(VRS;0-100)疼痛减轻≥30%的患者比例。次要结局指标包括在1个月和6个月时疼痛改善至少30%的患者比例,并且在随访时Oswestry残疾指数(ODI)从基线开始≥15%。
结果:在3个月时,H组的疼痛结局比N组更成功(59.09%vs.41.51%;P=0.002),但在1个月时没有(67.53%与64.78%;P=0.61)或6个月(27.13%vs21.55%:P=0.31)。对于功能结果,在3个月时,H组的应答者比例高于N组(70.31%vs.53.46%;P=0.002)。女性,年龄≤60岁和疼痛持续时间≤6个月与3个月终点时的优越结局相关.尽管椎间盘突出的患者在TFESI的治疗中总体效果更好,有利于H组的唯一差异是腰椎滑脱患者.
结论:3%高渗盐水作为TFESI的辅助成分是生理盐水的可行替代品,随机研究需要将其有效性与类固醇作为可能的替代方案进行比较。
背景:泰国临床试验注册IDTCTR20231110006。
BACKGROUND: Transforaminal epidural steroid injections (TFESI) are commonly employed to treat lumbosacral radiculopathy. Despite anti-inflammatory properties, the addition of 3% hypertonic saline has not been studied.
OBJECTIVE: Compare the effectiveness of adding 0.9% NaCl (N-group) vs. 3% NaCl (H-group) in TFESI performed for lumbosacral radiculopathy.
METHODS: This retrospective study compared TFESI performed with lidocaine, triamcinolone and 0.9% NaCl vs. lidocaine, triamcinolone and 3% NaCl. The primary outcome was the proportion of patients who experienced a ≥ 30% reduction in pain on a verbal rating scale (VRS; 0-100) at 3 months. Secondary outcome measures included the proportion of patients who improved by at least 30% for pain at 1 and 6 months, and who experienced ≥15% from baseline on the Oswestry disability index (ODI) at follow-up.
RESULTS: The H-group experienced more successful pain outcomes than the N-group at 3 months (59.09% vs. 41.51%; P = .002) but not at 1 month (67.53% vs. 64.78%; P = .61) or 6 months (27.13% vs 21.55%: P = .31). For functional outcome, there was a higher proportion of responders in the H-group than the N-group at 3 months (70.31% vs. 53.46%; P = .002). Female, age ≤ 60 years, and duration of pain ≤ 6 months were associated with superior outcomes at the 3-month endpoint. Although those with a herniated disc experienced better outcomes in general with TFESI, the only difference favoring the H-group was for spondylolisthesis patients.
CONCLUSIONS: 3% hypertonic saline is a viable alternative to normal saline as an adjunct for TFESI, with randomized studies needed to compare its effectiveness to steroids as a possible alternative.
BACKGROUND: Thai Clinical Trials Registry ID TCTR 20231110006.