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Alireza Gelinimoghaddam et al.
INTRODUCTION
Backache is the most common cause of limitations
among people above the age of 45 in modern societies
(Kozinoga et al., 2015). Backache is usually observed
among the middle-aged people with women being
more prone to it. The prevalence of backache among
the elderly is reported to be 84% (Balague et al., 2012).
Radicular pains are usually the result of nerve root
in ammation or, sometimes, take place without mechan-
ical stimulation (Chang et al., 2017). One of the major
complications caused by intervertebral disc herniation
is the epidural space and nerve roots in ammation. As
clinical studies indicate, radicular pain caused by nerve
root in ammation in epidural space is the result of disk
leakage, pressure on nerve root arteries or stimulation
of dorsal root ganglia due to spinal stenosis (Chang
et al., 2017).
As radicular backache may be caused by epidural
space and nerve root in ammation, the mechanism of
in ammation suppression and repression by steroid
medicines is largely used to treat this complication (Di
Donato et al., 2010). Steroids are powerful anti-in am-
matory medicines that reduce the in ammation caused
in nerve roots by disk herniation or other pathologies in
epidural space. Various studies conducted in this eld
have con rmed the effectiveness of epidural steroid
injection in reducing the acute in ammation of nerve
roots. In comparison to oral steroids, the superiority of
epidural steroid injection lies in using lower amounts
of medicines limited to the areas of the damaged nerve
roots and reduced possibility of these medicines’ side
effects (Nampiaparampil et al., 2012). Radicular pain
and backache relief, better cooperation of patient in
physiotherapy, improved life quality, less consumption
of analgesics and improved performance of the patient
are some advantages of lumbar epidural steroid injec-
tion (Kurgansky et al., 2016). Although steroid epidural
injections are largely used to reduce and control radicu-
lar pain, we should never forget the complication of this
method including spinal cord infarction, hypertrophy of
fat, menstrual changes and adrenal suppression (Bagheri
et al., 2015, Brinks et al., 2010 Sehmbi et al., 2017).
Epidural steroid injection is a lumbar disk closed
surgery method with various cognitive and therapeu-
tic advantages. In cognitive terms, analgesia following
local anesthetics injection to epidural space and the site
of possible damage highlights the role of epidural space
as the potential source of pain. Furthermore, the long
term pain relief of the patient for several weeks follow-
ing injection indicates existence of an in ammatory
component in patient’s pain and highlights the role of
injection in reduction of this in ammatory procedure
(White et al., 1980).
Fluoroscopy guided lumbar disk closed surgery is the
method currently used for this complication. Studies
have shown that injection is carried out in the wrong
are in 30% of the cases with no uoroscopy and contrast
con rmation (Manchikanti et al., 2004). High resolution
of linear probe, harmonic imaging of tissue, two dimen-
sional matrix probe technology, imaging with a wider
viewing area, and duppler sonography power are some
advantages of sonography in comparison with uoros-
copy. These advantages have turned ultrasound into a
superior tool for analyzing skeletal-muscular disease.
Previous studies have described sonography-guided
caudal epidural steroid injection with an accuracy equal
to uoroscopy and with advantages such as the simplic-
ity of this technique and refraining from being exposed
to radiation (Park et al., 2013).
Current available researches conducted in this eld
are focused on measuring the correct placement of nee-
dle in caudal epidural space with no evidences presented
concerning sonography-guided epidural injection and it
has never been compared with uoroscopy. Considering
the constraints and limitations of uoroscopy such as
ionizing radiation and reduction of injection side effects
such as random intravenous injection, researchers are
looking for a better alternative for uoroscopy. High
resolution of probe, harmonic imaging of tissue, two
dimensional matrix probe technology, imaging with a
wider viewing area, higher pace, and the greater ease of
injection are some advantages of sonography in com-
parison with uoroscopy. These advantages have turned
ultrasound into a superior tool for analyzing skeletal-
muscular disease. Considering the potential of ultra-
sound technique, the present research seeks to study
the success level of sonography-guided epidural steroid
injection and compare its effectiveness with uoroscopy
in treating lumbar radicular pain through a single-blind,
randomized, clinical trial.
MATERIAL AND METHODS
This is a clinical trial research. In a period of three
months, as many as 50 patients aging 23 to 70 suffer-
ing from lumbar radicular pain whose diagnosis was
con rmed through clinical les, medical examination
results and electromyographic tests or were diagnosed
with disk herniation or spinal stenosis in CTScan or MRI
took part in the research. With due observation of medi-
cal ethics principles and after obtaining the consent of
patients and making them aware of the research proc-
ess, the participants took part in the research voluntar-
ily. Systematic in ammatory diseases, treatment using
anticoagulants, uncontrolled diabetes, history of allergic
reaction to contrast material, diagnosed infection, der-
mal defects in the injected area, mental problems, history
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARATIVE STUDIES ON THE SUCCESS LEVEL OF SONOGRAPHIC GUIDED EPIDURAL STEROID INJECTION 149