Epidural steroid injections in chronic discogenic low back pain treatment
Background. Low back pain (LBP) remains one of the most common problems of the spinal column and chronic pain syndromes. It is a frequent cause of disability, and the treatment expense is quite high. Nowadays, there are three methods of treatment for discogenic pain: physiotherapy, drug therapy and surgery. Interventional treatment of discogenic pain by injecting drugs into the epidural space can equally be attributed to both minimally invasive surgery and active target therapy. The purpose of this study is to research the dynamic of pain among patients suffering from chronic discogenic low back pain taking epidural steroid injections as the treatment. Materials and methods. The retrospective study included 74 patients aged from 25 to 83 years (53.86 ± 14.27) treated from 2015 to 2017 in Neuromed Clinic and Uzhgorod Regional Center of Neurosurgery and Neurology. After a comprehensive examination, a therapeutically resistant chronic discogenic LBP was diagnosed in all patients. We applied interlaminar and transforaminal injections of corticosteroids under a radiological control of the C-arm. A total of 35 (47 %) transforaminal epidural injections, or blockades and 39 interlaminar epidural blocks were performed. Depending on the localization, the manipulations performed were distributed as follows: at L5-S1 level - 36 (48 %), at L4-L5 level - 17 (23 %), at L3-L4 level - 12 (16 %) and at L2-L3 level - 9 (12 %). Pain syndrome was assessed using a 10-point visual analogue scale (VAS) before manipulation, 7 and 30 days after treatment. Results. No complications were registered. All patients have reported a pain reduction. Most patients, right before the manipulation, complained about “a very strong or unbearable” pain (VAS 7.01 ± 0.86), and a week after the procedure, the majority of the patients confirmed that their pain turned to a “mild or sometimes moderate” (VAS 3.68 ± 0.87). A similar trend persisted a month after the manipulation (VAS 1.98 ± 1 01). Conclusions. Epidural injection of corticosteroids is a safe and effective way to treat a chronic lower back pain. This intervention technique can significantly reduce the intensity of suffering.