EPIDURAL INJECTIONS IN THE TREATMENT OF RADICULAR SYNDROME AND CHRONIC LUMBAR PAIN IN DEGENERATIVE-DYSTROPHIC SPINE DAMAGE

Abstract

Aim. To investigate the methodology and effectiveness of epidural steroid injection for radicular syndrome and lower back pain caused by degenerative-dystrophic process. Research methods: bibliosemantic, comparative, systemic. Results. A literature review and our study proved a high efficacy of both monotherapy and combined epidural steroid injections in treatment of chronic lumbar pain and radicular syndrome caused by degenerative-dystrophic spine damage. Epidural steroid injections are indicated for intervertebral disc herniation, spondyloarthritis, spinal canal stenosis, spondylolisthesis, which cause chronic lumbar pain, radicular syndrome. Epidural steroid blockades with stable remission were proved to have positive result in 20 to 100% of cases, averaging more than 80%. Anesthetics, corticosteroids, enzymes, and vitamins are administered to the epidural cavity to relieve pain and inflammation, but most authors still prefer steroids. Corticosteroids reduce the inflammatory response and oedema by inhibiting the synthesis and release of numerous anti-inflammatory mediators and cause the reverse local anaesthetic effect. Different approaches are used to introduce drugs into the epidural cavity: interlaminar, caudal and transforaminal; the method of long-term local pharmacotherapy is used. Interlaminar epidural steroid injection is as effective as transforaminal epidural injection. The middle interlaminar access is less traumatic. The choice of the administration technique depends on specialist experience and preferences. Epidural injections are performed both by a “blind method” (without imaging) and under control (fluoroscopy, ultrasound and CT) in order to improve the safety and carefulness of pharmacological drug administration. The equivalence of fluoroscopic, ultrasound and CT control of epidural injection in terms of treatment efficacy has been proved. Conclusions. Taking into account the high effectiveness of epidural steroid injections, the possibility of outpatient treatment in the absence of complications, makes it the method of choice in the treatment of radicular and lumbar pain caused by degenerative damage of the lumbar spine, after ineffective treatment.