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      Transforaminal epidural steroid injection combined with pulsed radio frequency on spinal nerve root for the treatment of lumbar disc herniation

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          Abstract

          Background

          Lumbar disc herniation (LDH) is a common disease in clinical practice. The symptoms recur and are aggravated by time; severe pain and long-term movement disorder cause physiological and psychological problems that affect the quality of life of patients. Therefore, relieving the pain symptoms and promoting functional recovery are the primary goals that have gained increased attention.

          Objective

          To assess the efficacy of CT-guided transforaminal epidural steroid injection (TFESI) combined with pulsed radio frequency (PRF) on spinal nerve root for the treatment of LDH.

          Study design

          Retrospective comparative study.

          Setting

          Shengjing Hospital of China Medical University.

          Methods

          A total of 135 patients with LDH were selected from the Department of Pain Management in the Shengjing Hospital of China Medical University between January 2014 and December 2016. All patients were divided into three groups according to the order of entry (n=45): TFESI (group A); PRF on spinal nerve root (group B); and TFESI combined with PRF on spinal nerve root (group C). The visual analog scale (VAS), Oswestry disability index (ODI), and global perceived effect (GPE) before treatment and at different time points after treatment were observed, and patients’ satisfaction was assessed.

          Results

          At every point of observation, the VAS and ODI decreased significantly as compared to that before treatment in all groups ( P<0.05). The VAS and ODI in group A at 3 and 6 months after treatment were significantly higher than that in the other two groups ( P<0.05). At day 1, day 14, and 1 month after treatment, the VAS and ODI in group C were significantly lower than that in group B ( P<0.05). The GPE in group C was high in the early days, while that at day 14 and 1 month after treatment was significantly higher than that in the other two groups ( P<0.05); no significant difference was observed in GPE at 3 and 6 months after treatment between groups B and C ( P>0.05).

          Conclusion

          TFESI combined with PRF for the treatment of LDH could effectively and rapidly relieve lumbago and radicular pain and achieve long-term remission. Although the method is widely applicable, the precise selection of patients is imperative.

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          Most cited references 38

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          Sciatica: review of epidemiological studies and prevalence estimates.

          Review of studies on sciatica prevalence and synthesis of available evidence. To assess the studies on sciatica prevalence, discuss reasons for variation in estimates, provide suggestions for improving accuracy of recording sciatica in epidemiological and outcome studies so as to enable better evaluation of natural history and treatment effect in the presence of low back pain related sciatica. Sciatica is a common cause of pain and disability. It is more persistent and severe than low back pain, has a less favorable outcome and consumes more health resources. However, sciatica prevalence rates reported in different studies and reviews vary considerably and provide no clear picture about sciatica prevalence. A literature search of all English language peer reviewed publications was conducted using Medline, EMBASE, and CINAHL for the years 1980-2006. Two reviewers extracted data on sciatica prevalence and definitions from the identified articles. Of the papers retrieved, 23 were included in the review. Only 2 studies out of the 23 used clinical assessment for assessing sciatic symptoms, and definitions of sciatica varied widely. Sciatica prevalence from different studies ranged from 1.2% to 43%. Sciatica prevalence estimates vary considerably between studies. This may be due to differences in definitions, methods of data collection and perhaps populations studied. Suggestions are made on how to improve accuracy of capturing sciatica in epidemiological studies.
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            Biomechanics of intervertebral disk degeneration.

            Degenerative changes in the material properties of nucleus pulposus and anulus fibrosus promote changes in viscoelastic properties of the whole disc. Volume, pressure and hydration loss in the nucleus pulposus, disk height decreases and fissures in the anulus fibrosus, are some of the signs of the degenerative cascade that advances with age and affect, among others, spinal function and its stability. Much remains to be learned about how these changes affect the function of the motion segment and relate to symptoms such as low back pain and altered spinal biomechanics. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy.

              Epidural steroid injection (ESI) is one of the most common nonsurgical interventions prescribed for back and leg pain symptoms. Although the use of ESI is widespread, proof of efficacy among the broad population of low back pain patients is lacking and use is predicated to a great extent on the cost and morbidity of the perceived "next step" in many patient's care-surgery. To review the relative indications and clinical features that predict success with ESI therapy, and to provide a physiological rationale to guide clinical decision-making. Review of literature and clinical experience. Clinical studies have alternately supported and refuted the efficacy of ESI in the treatment of patients with back and leg pain. Steroid medications do benefit some patients with radicular pain, but the benefit is often limited in duration, making efficacy difficult to prove over time. Steroids appear to speed the rate of recovery and return to function, however, allowing patients to reduce medication levels and increase activity while awaiting the natural improvement expected in most spinal disorders. Fluoroscopic verification of needle placement, with contrast injection, greatly improves steroid delivery while reducing risks. Although it is assumed that the benefit of steroids is related to their effect on inflammation, that remains unproven, and it is possible that benefit is gained through an unrecognized action. Randomized, controlled trials are needed to conclusively identify those patients most likely to benefit from ESI, and when and for how long. Until then, epidural steroids provide a reasonable alternative to surgical intervention in selected patients with back and/or leg pain, whose symptoms are functionally limiting. When appropriate goals are established and proper patients are selected, sufficient short-term benefit has been documented to warrant continued use of this tool.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                14 August 2018
                : 11
                : 1531-1539
                Affiliations
                [1 ]Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
                [2 ]Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China, zhaoguangyi110004@ 123456163.com
                Author notes
                Correspondence: Guangyi Zhao, Department of Anesthesiology, Shengjing Hospital of China Medical University, 36 San Hao Street, Shenyang, Liaoning, Shenyang 110004, China, Fax +86 1 894 025 7383, Email zhaoguangyi110004@ 123456163.com
                Article
                jpr-11-1531
                10.2147/JPR.S174318
                6097521
                © 2018 Ding et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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