Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT
Introduction: Treatment for Low Back Pain (LBP) due to Prolapsed Intervertebral Disc (PIVD) includes conservative management, Epidural Steroid Injection (ESI), and surgery. Transforaminal Epidural Steroid Injection (TFESI) is a more recently described approach. All corticosteroid preparations us...
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| Autores principales: | , , , , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Acceso en línea: | https://doaj.org/article/8b40ec452bb94027992547924d1b3b14 |
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| Sumario: | Introduction: Treatment for Low Back Pain (LBP) due to Prolapsed
Intervertebral Disc (PIVD) includes conservative management,
Epidural Steroid Injection (ESI), and surgery. Transforaminal Epidural
Steroid Injection (TFESI) is a more recently described approach. All
corticosteroid preparations used for TFESI are particulate except
dexamethasone and betamethasone sodium phosphate. But while
comparing methylprednisolone with dexamethasone, the latter has
more potent anti-inflammatory action with least likelihood of causing
embolic events and is also less expensive.
Aim: To compare the efficacy of transforaminal epidural injection
of dexamethasone and methylprednisolone in reducing LBP
and disability in prolapsed lumbar intervertebral disc amongst
the indigenous population of Manipur, India.
Materials and Methods: This was a randomised controlled study
on 80 patients with PIVD attending Outpatient Department (OPD)
at physical medicine and rehabilitation was conducted from
September 2016 to August 2018. A single dose of lumbar TFESI
with dexamethasone in the study group and methylprednisolone
in the control were given under C-arm guidance. The outcome
variables Visual Analog Scale (VAS) for pain and Oswestry Disability
Index (ODI) for function were measured at one week, one month
and six months. Statistical tests like t-test, Chi-square test were
used for intra group and inter group analysis.
Results: In the total sample of 80 patients, 40 (15 males and
25 females, mean age: 38.28±8.55 years) were categorised as
Dexamethasone patients and 40 (17 males and 23 females;
mean age: 39.28±7.80 years) as methylprednisolone patients,
there were significant improvement in mean score of VAS and
ODI in both the groups (p-value <0.05). At six months, both
treatment groups maintained initial observed improvements,
with no significant differences between groups on the VAS
{95% Confidence Interval (CI), -0.02 to 0.4; p-value=0.07} and
ODI (95% CI,-0.21 to 3.43; p-value=0.08).
Conclusion: Non-particulate steroid dexamethasone was similar
in efficacy to the particulate steroid methylprednisolone in
lumbar TFESI. However, in view of the greater safety profile of
dexamethasone, it is suggested that dexamethasone may be
used as the preferred agent in lumbar TFESI. |
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