To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI).
Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI.
After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI.
ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.
Citations
Method: Fifty low back pain patients who enrolled in Bundang CHA rehabilitation center from April 2000 to November 2001 with variable duration of HIVD, spinal stenosis and failed back surgery syndrome were treated with spinal epiduroscopy. The patients were grouped according to the duration and the disease. The efficacy of treatment was assessed with visual analog scale (VAS), Oswestry low back pain (LBP) questionnaire and Pain Disability Index (PDI) before the treatment, at 1 day, 1 week, 3 months and 6 months after the treatment.
Results: VAS of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05). PDI of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05). Oswestry LBP questionnaire of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05).
Conclusion: Spinal endoscopic epiduroplasty is one of the best treatment that can be applied to low back pain patients with variable duration of HIVD, spinal stenosis and failed back surgery syndrome.
Method: We investigated 28 patients with back and/or lower limb pain and weakness who were underwent lumbar spine operation. Seven patients who had undergone surgery due to spinal infection or fracture were excluded. Twenty-one patients included 7 female and 14 male patients with ages 20∼63 years, and the mean age was 44.4 years. The following data were evaluated: clinical symptoms, neurological examination, duration from operation to first visit, preoperative diagnosis, operation number and site, electrodiagnostic studies, radiologic studies (simple radiographs, epidurography, CT, MRI), and psychological evaluations (SCL-MPD).
Results: The time of the visit after the operation varied between one month and 15 years (mean 48.5 months). Electrodiagnostic study revealed lumbar radiculopathy in 18 patients and the most common level was at the fifth lumbar root. All eight patients who undergone epidurography showed filling defect or indentation. Psychologic evaluations were performed on five patients and they revealed high scores in depression and somatization.
Conclusion: Clinical and electrodiagnostic findings of lumbar radiculopathy, abnormal epidurographic findings and psychological results after lumbar disc operation were related to the causes of failed back surgery syndrome. (J Korean Acad Rehab Med 2003; 27: 388-393)
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