A COMPARATIVE STUDY BETWEEN INTRAVENOUS STEROID INJECTION AND INTERLAMINAR EPIDURAL STEROID INJECTION IN ACUTE LUMBAR PROLAPSED INTERVERTEBRAL DISC

Kanti Rajkumari; Longjam Nilachandra Singh; Akoijam Joy Singh; Shibu B; Tripti Swami; Chandrakant Pilania; Margaret Chabungbam

Volume : VII, Issue : IX, September - 2018

A COMPARATIVE STUDY BETWEEN INTRAVENOUS STEROID INJECTION AND INTERLAMINAR EPIDURAL STEROID INJECTION IN ACUTE LUMBAR PROLAPSED INTERVERTEBRAL DISC

Kanti Rajkumari, Longjam Nilachandra Singh, Akoijam Joy Singh, Shibu B, Tripti Swami, Chandrakant Pilania, Margaret Chabungbam

Abstract :

Background:Lifetime prevalence of low back pain can be as high as 84%. Prolapsed disc was believed to cause back and leg pain by mechanically compressing the nerve roots initially.It�s well known now that leakage of the contents of the nucleus pulposus causes pain producing an inflammatory reaction in the disc itself, around the facet joint and a chemical neuroradiculitis due to the release of various inflammatory mediators. Corticosteroids have long been hypothesized to be of benefit for radicular low back pain, although evidence supporting this hypothesis has been mixed. Based upon the suggestion of early benefit, this study was carried out in patients with radicular low back pain reasoning that, as with other neurological processes, a benefit was most likely to be found if intervention was initiated early in the course of the disease symptomatology. Previous systemic literature reviews have suggested at limited interest of systemic steroids in radicular low back pain. The results of most studies have been inconclusive, and none have compared the effectiveness of systemic corticosteroid administration with that of epidural corticosteroid injection which is one of the standard treatment modality in radicular low back pain due to interverteal lumbar disc prolapse.

Objective: To compare effectiveness of intravenous methylprednisolone 500 mg and epidural methylprednisolone 80 mg injection in reduction of pain and disability in acute lumbar prolapsed interverteal disc (PIVD).

Methods:A prospective, randomised and comparative study was performed in eighty patients who were allocated to 2 groups (Group A and B). Group A (n=40) received intravenous methylprednisolone in 250ml of 5% dextrose while Group B (n=40) received interlaminar epidural steroid injection. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used as outcome measures for pain and disability.

Results: The reduction of pain intensity as measured by VAS score showed significant reduction at the follow up periods in group B as shown by reduction in VAS score from 7.42 to 2.10 while that in group A was 7.34 to 5.16. Reduction in Oswestry Disability Index (ODI) from 71.42 to 19.4 in Group B was significantly more than that of radiating pain 70.89 to 42.68 in Group A(p=0.000).

Conclusion:Single dose of interlaminar epidural methylprednisolone injection is found to be more effective than intravenous methylprednisolone injection in reducing pain and disability in acute PIVD.