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Aug 17, 2018

ESRA-2018

4 - COMPARISON OF NON-PARTICULATE AND PARTICULATE STEROIDS IN FORAMINAL INJECTIONS FOR LUMBOSACRAL RADIULOPATHY

tfesi

particulate

steroids

Abstract

Abstract

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Keywords

tfesi

particulate

steroids

Abstract

Design: Prospective, randomised study Introduction: Particulate steroid methyl prednisolone acetate (MP) is the most commonly used agent for spinal foraminal injections. One major risk associated with foraminal injections with MP is inadvertent injection to radicular artery resulting in anterior spinal artery thrombosis which might lead to paraplegia. Non particulate steroid dexamethasone (DM) is devoid of such risk, however its’ long term effectiveness in lumbosacral radiculopathy remains uncertain. Materials and Methods: 45 patients (aged 21-65 years) with lumbosacral radiculopathy secondary to a single level prolapsed intervertebral disc (at L3-L4, L4-L5 or L5-S1) causing compression of exiting and/or traversing root(s) at that particular level were randomly assigned to receive foraminal injections either with MP (group MP; n=24) or with DM (group DM; n=21). All patients had predominant sensory symptoms (radicular pain and paraesthesia) following a dermatomal distribution, and the clinical pictures corroborated with the MRI findings. Patients with motor weakness, disturbed bladder or bowel functions, and those with associated psychological factors were excluded. The determination of level of foraminal injection was made jointly by the neurosurgeon and the pain-physician. All foraminal injections were performed by the same interventionist. All patients were assessed pre-procedure, and thereafter at 1 week, 1 month, 3 months and 6 months following the procedure, using Visual Analog Scale (VAS), Numeric Rating Scale (NRS) and Ronald Morris Back Pain and Disability Questionnaire (RMDQ). Results: The pain relief (in terms of VAS and NRS) were similar between the groups at 1 week, 1 and 3 months following injection, however those received MP had clinically better (statistically insignificant) pain relief at 6 months. Quality of life assessed by RMDQ were similar between the groups at all time intervals. There were no major or minor complications. Conclusion: Non particulate steroid DM could be a viable alternative of MP, with near similar effect in terms of pain relief.

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All rights reserved.