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To compare the long-term effect and safety of an epidural steroid injection in spinal stenosis patients, with or without local anesthetics.
Twenty-nine patients diagnosed with spinal stenosis were included and randomly divided into two groups. Translaminar epidural and selective nerve root spinal injection procedures were performed using steroids mixed with local anesthetics or normal saline. The effects of spinal injection procedures were measured with visual analogue scale (VAS) and functional rate index (FRI). These measurements were performed before injection, at 1 month after injection and at 3 months after injection. The occurrence of side effects was investigated each time.
The VAS and FRI scores were significantly reduced in both the local anesthetics group and normal saline group at 1 and 3 months after the injection. However, there was no significant difference in VAS and FRI score reduction between the two groups each time. Side effects are not noted in both groups.
The spinal injection procedures using steroids mixed either with local anesthetics or normal saline have an effect in reducing pain and improving functional activities. However, there was no significant difference between the two groups in relation to side effects and the long-term effects of pain and function.
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The syndrome of aortoiliac occlusive disease, also known as Leriche syndrome, is characterized by claudication, pain, and diminished femoral pulse. We highlight an unusual case of right sciatic neuropathy caused by Leriche syndrome, which was initially misdiagnosed. A 52-year-old male, with a past medical history of hypertension and bony fusion of the thoracolumbar spine, visited our hospital complaining of right leg pain and claudication, and was initially diagnosed with spinal stenosis. The following electrophysiologic findings showed right sciatic neuropathy; but his symptom was not relieved, despite medications for neuropathy. A computed tomography angiography of the lower extremities revealed the occlusion of the infrarenal abdominal aorta, and bilateral common iliac and right external iliac arteries. All these findings suggested omitted sciatic neuropathy associated with Leriche syndrome, and the patient underwent a bilateral axillo-femoral and femoro-femoral bypass graft.
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To identify the volumes of contrast material needed to reach the specific landmarks and contrast pattern during Kambin's triangle approach (KB-A) in lumbar spinal stenosis.
Sixty patients undergoing KB-A were investigated. Fifty-six patients were included in this study. KB-A were performed with the use of contrast-enhanced fluoroscopic visualization. After confirming the appropriate spinal needle position, a slow injection of up to 5.0 ml of nonionic contrast material was carried out. Under intermittent fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: ipsilateral inferior or superior neural foramen.
After 2.0 ml of contrast was injected, 93.2% of KB-A cases spread to the medial aspect of the inferior pedicle of the corresponding level of injection and 86.3% of KB-A spread to the medial aspect of the superior pedicle of the corresponding level of injection. After 3 ml of contrast was injected, 95.3% of KB-A spread to cover both the medial aspect of the inferior pedicle and the superior pedicle of the corresponding level of injection. A volume of 2 ml of injectate reaches the anterior epidural space 100% of the time.
This study demonstrates injectate volumes needed to reach the specific anatomic landmarks in KB-A. A volume of 3.0 ml of injectate reaches both the medial aspect of theinferior pedicle and the superior pedicle 94.6% of the time. Therefore, Interventionalists may consider a 1-level instead of a 2-level injection for patients with a bleeding risk or for 2 level central pathology.
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Achondroplasia is a congenital developmental condition characterized pathologically by defective enchondral ossification, affecting chiefly the long bones, and clinically by peculiar dwarfism with short extremities and normal trunk. One of the most common neurologic manifestation in achondroplastic patients in adulthood is spinal stenosis where the prominent characteristics of lumbar vertebrae structure are shortening of interpedicular distance and hypertrophy of vertebral pedicle. There has been no case report of traumatic cauda equina syndrome resulted in paraparesis among achondroplasic patients in Korea. We experienced a 30 year-old achondroplastic man sustained paraparesis as the result of an accidental slipping down. After the surgical decompression, the patient made slow recovery in all aspects of function via rehabilitation therapy.
Objective: To evaluate the efficacy of epidural injection for spinal stenosis with symptoms of low back pain, pseudoclaudication, or radiating pain.
Method: Thirteen patients with spinal stenosis which were confirmed by the computed tomography (CT) studies were treated with epidural injections of steroids and local anesthetics for three times with 1 week interval. The efficacy of epidural injection was assessed by visual analogue scale (VAS), pain rating score (PRS), treadmill test, and jump test.
Results: 1) The VAS, PRS, pain free walking distances, and jump heights were checked right before injection, and at 1 week and 3 months after injection. The VAS and PRS were significantly decreased after epidural injection. The pain free walking distances and the jump heights were significantly increased after epidural injecton.
Conclusion: Epidural injections of steroid and local anesthetics are effective in the short term period, but also in the long term period for patients with spinal stenosis.
Objective: The goal of this study was to determine the efficacy of caudal epidural injection in relieving pseudoclaudication of patients with lumbar spinal stenosis.
Method: Fifteen patients with a spinal stenosis which was confirmed by the magnetic resonance imaging(MRI) studies, received a caudal epidural steroid injection of triamcinolone acetate 120 mg, in a solution mixed with 2 ml of 1% lidocaine, and 15 ml of normal saline.
Results: The visual analogue scales checked at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection were 8.1⁑0.8, 3.7⁑1.7, and 6.4⁑1.9, respectively.
The exercise tolerance on the treadmill with 0o ramp inclination and 1.8 km/h speed was measured at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection. The time intervals to the first symptom of the pseudoclaudication were 2.3⁑0.8 minutes, 6.5⁑0.7 minutes, and 4.6⁑1.9 minutes, respectively.
Conclusion: In our study, the caudal epidural injection offered a significant short-term relief for the pseudoclaudication. Also it appeared to be a reasonable therapeutic option among patients with lumbar spinal stenosis after 1 month postinjection.
The purpose of this study was to see whether there were any correlations between the clinical findings and outcomes after the epidural steroid injection(ESI), and to determine which of the clinical findings might be of importance as favorable signs to predict a good result with the ESI.
The present study involves 23 elderly patients(18 females and 5 males) with spinal stenosis. The participants were divided into several subgroups according to the clinical features, such as presenting symptoms, age, duration of symptoms and physical findings. Subjects received the epidural injection of 80 mg Depo-Medrol with 6 ml of 1.5% lidocaine solution. The subjects completed a questionnaire before the ESI, and at three weeks and two months after the ESI respectively. The questionnaire included three scales on symptom severity, physical function, and satisfaction. The visual analogue pain scale was utilized as well.
At three weeks, satisfaction outcomes were encountered in 82.6 percent of the sudjects. Differences in the satisfaction between the subgroups according to the duration of symptoms and abnormal physical findings were statistically significant(P＜0.05). The total scores of symptom severity and physical function had improved from the baseline values(P＜0.0001). However, the score changes in each subgroup, for the duration of symptoms differ statistically same (P＜0.05) as assessed by the visual analogue pain scale. The results at two months were similar to those of at three weeks. Approximately 78.3% of the patients reported the satisfactory results. Although the follow up period was short, the results demonstrated that the epidural steroid injection afforded much improvement in clinical symptom and physical function in elderly patients with the lumbar spinal stenosis. The only significant difference was the satisfaction outcomes in the groups with short duration of symptoms. The determination of persisting outcomes from the ESI would require a long-term follow-up study.
The diagnostic value of nerve conduction study of spinal stenosis is far limited due to its deeply located lesion and its very short length of diseased nerve compared to the relatively long length of total conduction distance. Recently it became possible to stimulate the deep sited spinal nerve roots non-invasively with magnetic stimulation. The authors made a new method to calculate the motor nerve conduction time of lumbar spinal root using magnetic stimulation and planned to verify the delayed conduction time in patients with spinal stenosis who didn't show any abnormalities in the conventional electrophysiologic studies(peripheral nerve conduction velocity, F-wave and needle EMG).
Three steps of magnetic stimulation were applied to vertex(transcortical stimulation), T12 spinous process(thoracic stimulation) and S1 spinous process(sacral stimulation), and three channel recording were performed at rectus abdominis(RA), right and left abductor hallucis(AH) simultaneously. Central motor conduction time(CMCT) was calculated by time difference between vertex and spinal stimulation at RA and AH. Lumbar-segment motor conduction time(LMCT) was defined as conduction time by subtracting CMCT of RA from CMCT of AH. The results as follows;
LMCT was delayed in the group of patients with spinal stenosis(5.36⁑2.11 msec) compared to the normal control group(4.05⁑1.23 msec), but the range of LMCT was not quite different individually. Dividing the patients group into multi-level and single-level spinal stenosis group, LMCT in the multi-level spinal stenosis group was 6.12⁑1.95 msec which was significantly different from that of single-level(4.48⁑1.96 msec). The authors conclude that LMCT, the short segmental motor nerve conduction study of lumbosacral nerve root, is useful to confirm the entrapment of spinal nerve root across the lumbosacral spinal canal and is also non- invasive, simple and applicable to any other spinal nerve roots.
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