Abstract | STUDY DESIGN: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. OBJECTIVE: SUMMARY OF BACKGROUND DATA:
Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. METHODS: RESULTS: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. CONCLUSION: This assessment shows that in patients with axial or discogenic pain in the lumbar spine after excluding facet joint and SI Joint pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back pain with a potential superiority for a lumbar interlaminar approach over a caudal approach.
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Authors | Laxmaiah Manchikanti, Vidyasagar Pampati, Ramsin M Benyamin, Mark V Boswell |
Journal | International journal of medical sciences
(Int J Med Sci)
Vol. 12
Issue 3
Pg. 214-22
( 2015)
ISSN: 1449-1907 [Electronic] Australia |
PMID | 25678838
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anesthetics, Local
- Steroids
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Topics |
- Adult
- Anesthesia, Caudal
- Anesthetics, Local
(administration & dosage)
- Chronic Pain
(drug therapy, pathology)
- Female
- Humans
- Injections, Epidural
- Intervertebral Disc Displacement
(drug therapy, pathology)
- Low Back Pain
(drug therapy, physiopathology)
- Lumbar Vertebrae
(drug effects, pathology)
- Male
- Middle Aged
- Pain Management
- Randomized Controlled Trials as Topic
- Steroids
(administration & dosage)
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