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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oai:doaj.org-article:8b40ec452bb94027992547924d1b3b142021-11-10T06:09:53ZTransforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT10.7860/JCDR/2021/48704.153702249-782X0973-709Xhttps://doaj.org/article/8b40ec452bb94027992547924d1b3b142021-09-01T00:00:00Zhttps://www.jcdr.net/articles/PDF/15370/48704_CE[Ra1]_F[SK]_PF1(AKA_RK)_PFA(AKA_KM)_PN(KM).pdfhttps://doaj.org/toc/2249-782Xhttps://doaj.org/toc/0973-709XIntroduction: 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.Kanti RajkumariAkoijam Joy SinghLongjam Nilachandra SinghMargaret ChabungbamC SreejithMoirangthem JanetMonica MoirangthemTasso OpoJCDR Research and Publications Private Limitedarticlefunctional improvementoswestry disability indexsteroidsvisual analog scaleMedicineRENJournal of Clinical and Diagnostic Research, Vol 15, Iss 9, Pp KC06-KC09 (2021) |
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functional improvement oswestry disability index steroids visual analog scale Medicine R |
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functional improvement oswestry disability index steroids visual analog scale Medicine R Kanti Rajkumari Akoijam Joy Singh Longjam Nilachandra Singh Margaret Chabungbam C Sreejith Moirangthem Janet Monica Moirangthem Tasso Opo Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| description |
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. |
| format |
article |
| author |
Kanti Rajkumari Akoijam Joy Singh Longjam Nilachandra Singh Margaret Chabungbam C Sreejith Moirangthem Janet Monica Moirangthem Tasso Opo |
| author_facet |
Kanti Rajkumari Akoijam Joy Singh Longjam Nilachandra Singh Margaret Chabungbam C Sreejith Moirangthem Janet Monica Moirangthem Tasso Opo |
| author_sort |
Kanti Rajkumari |
| title |
Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| title_short |
Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| title_full |
Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| title_fullStr |
Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| title_full_unstemmed |
Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT |
| title_sort |
transforaminal epidural injection of dexamethasone vs methylprednisolone in reducing low back pain and disability in prolapsed lumbar intervertebral disc in manipur, india: a rct |
| publisher |
JCDR Research and Publications Private Limited |
| publishDate |
2021 |
| url |
https://doaj.org/article/8b40ec452bb94027992547924d1b3b14 |
| work_keys_str_mv |
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