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, 11, 1531-1539
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Transforaminal Epidural Steroid Injection Combined With Pulsed Radio Frequency on Spinal Nerve Root for the Treatment of Lumbar Disc Herniation

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Transforaminal Epidural Steroid Injection Combined With Pulsed Radio Frequency on Spinal Nerve Root for the Treatment of Lumbar Disc Herniation

Yuanyuan Ding et al. J Pain Res.

Abstract

Background: Lumbar disc herniation (LDH) is a common disease in clinical practice. The symptoms recur and are aggravated by time; severe pain and long-term movement disorder cause physiological and psychological problems that affect the quality of life of patients. Therefore, relieving the pain symptoms and promoting functional recovery are the primary goals that have gained increased attention.

Objective: To assess the efficacy of CT-guided transforaminal epidural steroid injection (TFESI) combined with pulsed radio frequency (PRF) on spinal nerve root for the treatment of LDH.

Study design: Retrospective comparative study.

Setting: Shengjing Hospital of China Medical University.

Methods: A total of 135 patients with LDH were selected from the Department of Pain Management in the Shengjing Hospital of China Medical University between January 2014 and December 2016. All patients were divided into three groups according to the order of entry (n=45): TFESI (group A); PRF on spinal nerve root (group B); and TFESI combined with PRF on spinal nerve root (group C). The visual analog scale (VAS), Oswestry disability index (ODI), and global perceived effect (GPE) before treatment and at different time points after treatment were observed, and patients' satisfaction was assessed.

Results: At every point of observation, the VAS and ODI decreased significantly as compared to that before treatment in all groups (P<0.05). The VAS and ODI in group A at 3 and 6 months after treatment were significantly higher than that in the other two groups (P<0.05). At day 1, day 14, and 1 month after treatment, the VAS and ODI in group C were significantly lower than that in group B (P<0.05). The GPE in group C was high in the early days, while that at day 14 and 1 month after treatment was significantly higher than that in the other two groups (P<0.05); no significant difference was observed in GPE at 3 and 6 months after treatment between groups B and C (P>0.05).

Conclusion: TFESI combined with PRF for the treatment of LDH could effectively and rapidly relieve lumbago and radicular pain and achieve long-term remission. Although the method is widely applicable, the precise selection of patients is imperative.

Keywords: low back pain; lumbar disc herniation; pulsed radio frequency; radicular pain; spinal nerve root; transforaminal epidural steroid injection.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic illustration of the study design. Note: All 135 patients were included in the treatment. Abbreviations: TFESI, transforaminal epidural steroid injection; PRF, pulsed radio frequency.
Figure 2
Figure 2
CT guidance. Notes: (A) Puncture site was determined by CT scan, and was located at the spinal nerve root, as indicated by the arrow; (B) CT scan showed that the radio frequency needle was located at the spinal nerve root on the left side, as indicated by the arrow; and (C) three-dimensional CT reconstruction showed multisegmental intervertebral foramen needle shadow, as indicated by the arrow.
Figure 3
Figure 3
Comparison of visual analog scale (VAS) scores before and after treatment in the three groups. Notes: (A) Changes in low back pain VAS scores; (B) changes in radicular pain VAS scores. Results are presented as mean ± SD. Compared to before treatment, *P<0.05; group B compared to group A, P<0.05; group C compared to group A, P<0.05; group C compared to group B, #P<0.05.

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