Med Journal June 2021 | Page 7

Table 1 : Prolapsed Discs

( LE ) ( n = 25 ) ( CE ) ( n = 25 ) ( TFE ) ( n = 25 ). ( IM ) ( n = 25 ) VAS Initial 9.54 + 4.01 9.17 + 3.31 8.92 + 3.06 9.26 + 2.74

Age ( years ) 41.16 + 11.33 39.99 + 8.82 42.21 + 9.74 37.64 + 7.48 Gender Female ( n ) 9 7 6 9 Gender Male ( n ) 16 18 19 16 Pain Relief n = 19 / 25 n = 16 / 25 n = 17 / 25 n = 16 / 25 Injections (#) n = 44 / 75 n = 49 / 75 n = 41 / 75 n = 67 / 75 *

Table 2 : Extruded Discs

( LE ) ( n = 25 ) ( CE ) ( n = 25 ) ( TFE ) ( n = 25 ). ( IM ) ( n = 25 ) VAS Initial 8.79 + 3.2 8.98 + 2.72 9.05 + 2.98 9.19 + 2.44

Age ( years ) 41.16 + 11.33 42.21 + 9.74 39.99 + 8.82 35.42 + 5.84 Gender Female ( n ) 9 7 8 10 Gender Male ( n ) 16 18 17 15 Pain Relief n = 11 / 25 n = 8 / 25 n = 16 / 25 * 5 / 25 Injections (#) n = 53 / 75 n = 59 / 75 n = 49 / 75 n = 70 / 75 *

Table 3 : Sequestered Discs

( LE ) ( n = 25 ) ( CE ) ( n = 25 ) ( TFE ) ( n = 25 ). ( IM ) ( n = 25 )

VAS Initial 8.54 + 4.01 9.17 + 3.31 8.92 + 3.06 9.21 + 2.31

Age ( years ) 41.16 + 11.33 39.99 + 8.82 42.21 + 9.74 38.95 + 3.87 Gender Female ( n ) 9 7 6 7 Gender Male ( n ) 16 18 19 18 Pain Relief n = 7 / 25 n = 4 / 25 n = 16 / 25 # * n = 2 / 25 Injections (#) n = 51 / 75 n = 64 / 75 n = 38 / 75 #* n = 73 / 75

* P < 0.05 between groups ; # P < 0.05 within groups ; LE ( lumbar epidural steroid ); CE ( Caudal epidural steroid ); TFE ( Transforaminal epidural steroid ); IM ( Intramuscular steroid ) with CF specialists to communicate with their families after positive screening .

It is our hypothesis that the origin of sciatic pain is reported to be multifactorial , involving mechanical stimulation of the nerve ends of the external portion of the fibrous ring , direct compression of the nerve roots ( with or without ischemia ), and a series of inflammatory phenomena induced by the extruded nucleus . ( 9,10 ) The breach of the posterior longitudinal ligament caused by an extruded or sequestered disc herniation exposes the herniated disc to the vascular bed of the epidural space , and inflammatory cells originating from these vessels on the periphery of the herniated disc material may have an important role in irritating the nerve roots and inducing sciatic pain . This study demonstrated that lumbar interlaminar , caudal , transforaminal , and intramuscular epidural injections are all efficacious but are not statistically more efficacious when compared to intramuscular injections in patients with contained disc herniations . On the other hand , in the extruded and sequestered disc herniation groups , direct steroid contact from the transforaminal steroid injections occurs between the injected steroid and the inflamed nerves ; this is one reason for the increased efficacy of the transforaminal steroid injections noted in these study results . All interventions and medications come with risks that may be offset by variable levels of analgesic benefit . Since steroids injected into the epidural space are not FDA-approved , clinicians recommending or performing such procedures must carefully outline the risks without minimizing them , especially for vulnerable patients who may otherwise disregard such risks in the presence of unrelenting , intolerable pain . It is our conclusion that lumbar steroid injection therapy success depends not only on the type of disc herniation but also on the proper selection of the method of the epidural steroid delivery .

References

For a complete list of references , email ams @ arkmed . org .

Volume 117 • Number 12 june 2021 • 271