Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study
Abstract
Background & Objective: The management of lumbar disc herniation (LDH) may involve the surrounding tissues, and attract neovascularization facilitated macrophage aggregates. Epidural triamcinolone might have a half-life ranging from 10−31 days; 80 mg methylprednisolone might improve the pain up to 1 week. The higher doses of steroids will lead to adrenal cortex suppression and osteopenia. We evaluated the effect of treatment with 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at 2 weeks, and 3 and 6 months follow-up.
Methodology: We enrolled seven males (38.9%) and 11 females (61.1%) with mean age 44 ± 23 y in the study. Eight (44.44%) subjects were younger than 51 y old, whereas the 10 (55.56%) subjects were ≥ 51 y old. Twelve (66.7%) subjects had had a bulged disc, and 6 (33.3%) subjects had disc protrusion. We injected 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at the site of disc lesion. Pain scores were measured with NRS scale and Oswestry Disability Index (ODI) scores at 2 weeks, and 3- and 6-months follow-up.
Results: The NRS score improved at 2 weeks, 40% to 71.43%, at 3 months 60% to 100%, and 6 months 80% to 100%. And the Oswestry Disability Index (ODI) score was improved at 2 weeks from 23.5% to 68.18%), at 3 months from 39.13% to 100%, and at 6 months 82.35% to 100%. A significant association was observed between age older than 50 y old and ODI scores at 2 weeks followed up.
Conclusions: The intra-epidural 1500 IU hyaluronidase before triamcinolone brings better results even though using a lower dose of triamcinolone. This approach showed the lower-cost better pain scores as compared to the routine use of heavy doses of triamcinolone for managing bulged and protruding LDH.
Abbreviations: ACTH: Adrenocorticotropic hormone; CRH: Corticotropin releasing hormone; CSF: Cerebrospinal fluid; HPA: Hypothalamus-Pituitary-Adrenal; ESI: Epidural steroid injection; LDH: Lumbar disc herniation; MRI: Magnetic resonance imaging; NRS: Numerical Rating Scale; ODI: Oswestry Disability Index; TNF-α: Tumor necrosis factor-alpha; VAS: Visual analogue scale
Key words: Bulged disc; Disc protrusion; Lumbar disc herniation; NRS; ODI; Caudal epidural; Adhesiolysis
Citation: Budisulistyo T, Husni A, Pramukarso DT, Pudjonarko D. Effect of caudal epidural adhesiolysis on pain and daily activities among chronic lumbar disc herniation patients. Anaesth. pain intensive care 2022;26(6):198−203.
Received: Sep 06, 2022; Reviewed: Oct 09, 2022; Accepted: Oct 21, 2022
