Spinalkanalstenose Injektionen

Epidurale Steroid-Injektionen für Behandlung von Stenosen Es wurde berichtet, für einige Patienten mit lumbalen Spinalkanalstenose hilfreich bei der kurzfristigen Schmerzlinderung zu sein.^11,12,17,18 Jedoch, few controlled trials have investigated the efficacy of epidural steroid injection in the treatment of lumbar spinal stenosis. Hoogmartens and Morelle¹⁷ and Rosen and coworkers¹⁸ retrospectively evaluated the effectiveness of epidural steroid injections and reported that approximately 50% of patients received short-term pain relief.




Much controversy exists with respect to the efficacy and patient satisfaction associated with steroid injections for lumbar spinal stenosis. Given the lack of research evidence for efficacy and the potential for complications, their use has been considered largely as an attempt to avoid surgery after the failure of other conservative management approaches.^19,20,21

Injections for Sciatica Pain Relief

The anti-inflammatory effect of epidural injections is increasingly accepted as the probable mechanism of pain relief in patients suffering from sciatica, based on the neurogenic inflammatory basis for pain generation. There are now 18 randomisierten Studien in der Literatur, wobei etwa die Hälfte, die einen positiven Nutzen. Während die meisten der Studien sind für Ischias aus Vorfall Gallertkern, einer Studie untersuchten nur Patienten mit lumbalen Stenose (Fukusaki) und eine Studie eingeschlossenen Patienten sowohl mit LSS und HNP (Cuckler).

Kontroverse um Studien

Fukusaki berichteten einige kurzfristige Wirksamkeit (Vierteljahr) von epidurale Steroide. Cuckler concluded that the epidural steroids were no better than local anesthesia. Cuckler’s methods have been criticized, jedoch, specifically his assumption that patients should expect to experience relief of symptoms within 24 hours or be considered treatment failures. The treatment regimen now recommended by NASS is an initial injection, after which the patient’s response is determined. It is current opinion that at least a week should pass after the initial injection before subsequent injections are considered, and there is no rationale for a series of injections without considering the response to the initial injection. In neither Cuckler’s study nor Fukusaki’s study was fluoroscopic guidance used. Instead, the loss of resistance (LOR) method was used for determining correct needle placement. Diese Methode hat sich gezeigt, um eine korrekte Nadelplatzierung als Durchleuchtungs geführte Nadelplatzierung und aktuelle Behandlungsrichtlinien weniger zuverlässig empfehlen dringend die Verwendung von Durchleuchtung.

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