Original ArticleEfficacy of Caudal Epidural Steroid Injection with Targeted Indwelling Catheter and Manipulation in Managing Patients with Lumbar Disk Herniation and Radiculopathy: A Prospective, Randomized, Single-Blind Controlled Trial
Section snippets
Background
Lumbosacral radiculopathy, developing from compression of ≥1 spinal nerve roots, is characterized by radiating leg pain, leg paresthesia, and neurologic impairment.1 Lumbar disk herniation (LDH), defined as localized disk displacement beyond the margins of the intervertebral disk space, is considered a common cause of lumbosacral radiculopathy.2, 3, 4, 5
Conservative interventions include advice, medication, traction, manipulation, stabilization exercise, physical therapy, laser, ultrasound, and
Study Design
The study was a prospective, randomized, single-blind, controlled trial. The study was conducted in accordance with the principles of the Declaration of Helsinki.13 Approval to perform the study was obtained from the ethics committee. Each participating center has obtained Institutional Review Board approval. All the participants signed informed consents before the study.
Inclusion Criteria
Inclusion criteria included 1) patients aged 18–70 years, 2) complaints of radiating leg pain, 3) correlative imaging
Patient Demographic and Clinical Characteristics
Database records of patients treated in our institution for symptomatic lumbar disk herniation between April 2016 and March 2017 were prospectively collected and analyzed. Of the 88 eligible patients, 3 did not fulfill the inclusion criteria. The remaining 85 eligible patients and their 4 weeks' follow-up at our institute were included in the study. They were categorized with a randomization schedule into the Catheter Group (43 patients, 50.6%) and No-Catheter Group (42 patients, 49.4%),
Discussion
Transforaminal ESI, also known as “nerve block,” places a needle alongside the nerve as it exits from the spine and injects medication into the “nerve sleeve.” The medication then travels up the sleeve and into the epidural space from the side. Transforaminal ESI can be modified better recovery. Caudal approach ESI, often referred as “epidural injection,” places the needle into the epidural space through the sacral hiatus, dispersing the steroid to a wider area. With the caudal approach, the
Conclusion
We conducted a prospective, randomized, single-blind controlled trial to assess the efficacy of caudal ESI with a targeted indwelling catheter combined with “4-step” manipulative therapy for patients with LDH. Both methods were effective in reducing pain intensity (VAS) and functional disability (JOA and ODI scores) compared with pretreatment. And the Catheter Group showed more significant decrease in VAS (back and leg) and greater changes in JOA and ODI scores of short/term follow-up, compared
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Conflict of interest statement: The authors received the following funding support: development of Chinese medicine in Shanghai 3-year action plan (2014–2016): Shanghai TCM clinical research base construction ZY3-LCPT-1-1003; construction of famous traditional Chinese medicine doctor “Mo Wen” and workshop in Pudong New Area PDZYXK-3-2014018; Natural Science Foundation of China (81403419); Clinical Research Plan of SHDC (16CR4011A, 16CR3074B,12012205); Shanghai Municipal Commission of Health and Family Planning (20164Y0081); Science and Technology Committee of Shanghai(17401934400, 16401930600).
Mengchen Yin, Wen Mo, Haiyang Wu, Jinhai Xu, and Jie Ye contributed equally to this work and should be considered as equal first authors.