La infiltración peri-radicular en pacientes con radiculopatía.(Inglés)

Peri-radicular infiltration is safe and provides short-term benefit to patients with radicular pain due to spinal stenosis or lumbar disc herniation (LDH), reports a study from the United Kingdom.

Peri-radicular infiltration to treat redicular pain has been demonstrated in several studies, but few prospective data are available on its efficacy of relieving radicular pain associated with spinal stenosis.

To evaluate the therapeutic efficacy of peri-radicular infiltration in this patient group, Leslie Chong Lich Ng, MD, Leicester General Hospital, and colleague prospectively examined 117 evaluable patients - 62 with spinal stenosis and 55 with LDH - who had clinical evidence of unilateral radicular pain and confirmed nerve root compression secondary to LDH or spinal stenosis. All patients were treated with peri-radicular infiltration. Efficacy was determined based on Oswestry disability index score (ODI), change in visual analogue scales (VAS) for radicular pain, and absolute value of the low back outcome score (LBOS).

At 6 and 12 weeks, there was a statistically significant difference in functional outcome between the patients. Compared to patients with spinal stenosis, patients with LDH had significantly greater changes in ODI and LBOS (2 vs. 9; P = .008 at 6 weeks and 6 vs. 13; P = .005 at 12 weeks, respectively) and (25 vs.29; P = .05 at 6 weeks and 26 vs. 34; P = .002 at 12 weeks, respectively). At final follow up, an overall reduction of at least 10% was found in 58% of the patients in the LDH group and 37% in the spinal stenosis group. No significant changes in VAS score was noted for either group at 6 or 12 weeks.

Multivariate analysis showed that modified Zung depression scale (MZDS), modified somatic perception questionnaire (MSPQ), and age at injection were significantly associated with outcome, with higher scores on these measures linked to poorer outcome.

The authors conclude that peri-radicular infiltration is safe and offers significant short-term benefit to many patients with radiculpathy, with significantly better response in patients with LDH compared to patients with spinal stenosis.