title: Transforaminal nerve root sleeve injection with corticosteroids, hyaluronidase, and local anesthetic in the failed back surgery syndrome.
abstract: Millions of patients with chronic sciatica are still treated with epidural corticosteroids. The efficacy of epidural corticosteroids remains questionable, especially in the chronic failed back surgery syndrome (CFBSS). The affected nerve root sleeve(s) are localized with the help of fluoroscopy and contrast dye. Local anesthetic diluted in 1,500 U hyaluronidase and 40 mg methylprednisolone is injected. Twenty patients with CFBSS, a small retrospective pilot study group, were treated. The success rate is evaluated using a verbal pain rating scale, 1 month and 3 months after the last injection. Initially, 12 patients obtained very good pain relief, sustained for >3 months in 11 patients. In one patient, pain returned after >1 month. No complications were observed. This technique is worthwhile for patients with CFBSS and where epidural fibrosis is suspected to be the pain origin.
authors.affiliation: Department of Anesthesia, Pain Clinic, University Hospital of Ghent, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Devulder
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy* / Q000209:etiology; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002921:Cicatrix / Q000150:complications / Q000188:drug therapy; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis; D005471:Fluoroscopy; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage / Q000627:therapeutic use*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010292:Paresthesia / Q000188:drug therapy / Q000209:etiology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012585:Sciatica / Q000188:drug therapy* / Q000209:etiology; D013126:Spinal Nerve Roots / Q000473:pathology; D013577:Syndrome; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D006821:Hyaluronoglucosaminidase; D008775:Methylprednisolone; D002045:Bupivacaine