Degenerative Lumbar Spine Disease : assssment of changes in epidural infusion pressure and clinical outcome after epidural steroid injection

Abstract EN

Objective : assessment of the effect of epidural steroid injection on epidural infusion pressure and clinical outcome variables in low back pain patients due to degenerative lumbar spine disease.

Methodology : this study was conducted on 40 patients, 29 males and 11 females complaining of radicular low back pain with radiological evidence of degenerative lumbar spine disease referred from Rheumatology & Rehabilitation Department to the Pain Clinic of the Anesthesiology Department of Zagazig University Hospitals.

They were classified into two groups : Group I : patients who exhibited lumbar degenerative spine disease (DSD) for less than 1 year (early DSD).

Group II : patients who exhibited lumbar degenerative spine disease (DSD) for more than 1 year (advanced DSD).

At starting therapeutic intervention and after 6 weeks of treatment, low back pain intensity, tension sign (straight leg raising test), functional disability, lumbar mobility and infusion epidural pressure were assessed for both groups.

Results : group I (early DSD): A significant decrease in epidural infusion pressure from baseline level was observed after epidural steroid injections (p < 0.05) ; significant improvements in pain, disability, lumbar mobility and tension sign (Straight leg raising test) were observed when comparing baseline values with that at the end of treatment.

Group II (advanced DSD) : insignificant decrease in epidural infusion pressure from baseline level was observed after epidural steroid injections (p > 0.05).

Also, insignificant improvements in pain, disability, lumbar mobility and tension sign (Straight leg raising test) were observed when comparing baseline values with that at the end of treatment (p > 0.05).

Conclusion : epidural steroid injections may be of benefit to patients with early DSD whose symptoms do not improve with more conservative management.

They may serve as a low-risk alternative to surgery in patients with degenerative lumbar spine disease.

But the role of steroid injections not to replace physical activity and therapy ; rather, steroids serve to control pain so that patients can work with therapists on their biomechanics and improve their functional outcomes.

Further researches must be done to clarify more information about the mechanism of action of epidural steroids in treatment of spine disease, its effect on epidural infusion pressure and to define accurately the relative indications and clinical features that predict success with epidural steroid injections (ESI) therapy.