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The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain: a randomized, blinded, prospective study.
BACKGROUND CONTEXT: Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.
PURPOSE: The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).
STUDY DESIGN: A randomized controlled trial was performed.
PATIENT SAMPLE: We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.
OUTCOME MEASURES: The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.
METHODS: The LA group (Group L, n=50) received 10 mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10 mL 0.25% bupivacaine+40 mg methylprednisolone at L4-L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.
RESULTS: There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.
CONCLUSIONS: Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid.
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