Short communication, Note

"Blind" interlaminar epidural steroid injections in lumbar spinal stenosis; effective and safe technique in elderly patients

NEVEN ELEZOVIĆ ; Department of Anesthesiology and Intensive Care, University Hospital Split, Spinčićeva 21, 21000 Split, Croatia
MLADEN CAREV orcid.org/0000-0003-2209-9331 ; Department of Anesthesiology and Intensive Care, University Hospital Split, Spinčićeva 21, 21000 Split, Croatia
SANDA STOJANOVIĆ STIPIĆ ; Department of Anesthesiology and Intensive Care, University Hospital Split, Spinčićeva 21, 21000 Split, Croatia
DRAGICA KOPIĆ ; Department of Anesthesiology and Intensive Care, University Hospital Split, Spinčićeva 21, 21000 Split, Croatia
IVAN RADOŠ ; Department of Anesthesiology and Intensive Care, University Hospital Osijek, J. Huttlera 4, Osijek, Croatia
SREČKO LJUBIČIĆ ; Department of Anesthesiology and Intensive Care, General Hospital Dubrovnik, Dr. R. Mišetića bb, Dubrovnik, Croatia

Abstract

Background and purpose: Blind interlaminar epidural steroid injection
(BESI) is one of the treatment modalities for lumbar spinal stenosis
(LSS). There are a growing number of elderly patients with LSS. The
optimal timing and outcome of BESIs in this population are not well
defined, which is the aim of this study.

Patients and methods: Thirty patients aged 67±1.5 yrs, with diagnosis
of LSS and refractory painwere recruited during year 2010 and followed up for 12months. “Blind” epidural in corresponding interspace was performed with 18G Tuohy needle, using loss of resistance. The epidural mixture (10ml) consisted of 80 mg of triamcinolone acetonide and 40mg of lidocaine. Each patient received in total 3 BESIs every 3 weeks (BESI1, BESI2, BESI3). The pain was evaluated with visual analogue scale (VAS) before first BESI (VAS0) and after each treatment (VAS1, VAS2, VAS3). Subjective quality of performing the same physical activity (PA) was evaluated with simple 3-points scale (0 = no change, 1 = slight improvement, 2 = significant improvement).

Results: BESI resulted in significant reduction of VAS (VAS0 8.1±0.3,
VAS1 5.8±0.2, VAS2 4.9±0.2, VAS3 4.4±0.3; F=87.57, P< 0.001) – all
pair-wise comparisons were significantly different in post-hoc analysis
(P<0.001), except VAS2 vs VAS3 having borderline significance (P=0.06). Subjective quality of physical activity significantly improved regarding baseline conditions (BESI1 PA score: 0=1/30,1=7/30, 2=22/30 patients; BESI2 PA score:0=1/30,1=5/30,2=24/30 patients; BESI 3 PA score: 0=4/30, 1=6/30, 2=20/30 patients; c2=3.7, p=0.45). The average duration of successful BESI treatmentwas 6.3±0.8months (range 1–12). There were no reported complications.

Conclusions: Blind interlaminar epidural steroid injections (in total 3
injections every 3 weeks) resulted in significant reduction of pain and
improvement of physical activity in elderly patients with LSS. It could be regarded as effective and safe procedure in this population.

Keywords

low back pain; spinal stenosis; epidural analgesia; steroids; chronic pain; pain clinics

Hrčak ID:

105991

URI

https://hrcak.srce.hr/105991

Publication date:

1.6.2013.

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