Abstract
Introduction: The treatment with epidural steroids and local anaesthetic for radicular pain arising from nerve root compression is a commonly utilised and recognised treatment. The aim of this study is to determine the efficacy of CT-guided injection of epidural steroids without anaesthetic for radicular pain but without clinical neurology in the presence of a degenerative of lytic spondylolisthesis and concomitant foraminal narrowing.
Method: The study subjects, 21 in total, were selected over a 1-year period by the surgeon. All patients had either degenerative or lytic spondylolisthesis as determined by CT, MRI and plain film and were suffering from radicular pain – sharp, shooting and burning in the L5 or S1 dermatome. For inclusion, there had to be no associated evidence of nerve root compression. All patients completed, prior to epidural therapy, a pain diagram, visual analogue scale (VAS) of pain severity on a scale of 1 to 10 and Oswestry Disability Index (ODI). The MRI and clinical pain picture were correlated. The level of the spondylolithesis was determined.
Highly selective CT-guided epidural steroid injection was then carried out at the level of spondylolithesis by an experienced interventional radiologist. The pain diagram, VAS of pain severity and ODI were all completed again by the subjects themselves or by telephone at 1 and 3 months after injection in the presence of an independent assessor (nurse) and then reviewed and discussed with the treating doctor. All subjects were also asked to complete a functional questionnaire.
Results: One month after injection 86% of those treated had greater than 50% radicular pain relief and from this group 72% had radicular pain reduction of greater than 80%. All had improvement in function. All of the above, confirmed that their quality of life had certainly improved. Three months after injection 76% of those treated still had a reduction in their radicular pain of greater than 50% (92% of these still had pain reduction of over 80%). Again all reported continued functional improvement.
Discussion: Despite the small sample size, this study highlights the short-term Benefit of CT-guided steroid epidural injections with symptomatic lumbosacral spondylolisthesis and spondylolysis with radicular pain. Pain can be relieved without anaesthesia. The mechanisms of pain relief are speculative.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
