OBJECTIVE: The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. MATERIALS AND METHODS: We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. RESULTS: Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). CONCLUSION: There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.
Adrenal Cortex Hormones/*therapeutic use ; Adult ; Aged ; Cervical Cord/physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement/*drug therapy/radiography ; Male ; Middle Aged ; Radiculopathy/*drug therapy/radiography ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the feasibility of no antibiotic administration to prevent infection during the perioperative period of percutaneous intradiscal ozone-injection for treatment of lumbar disc herniation.

METHODSSeventy-two patients with lumbar disc herniation but normal body temperature as well as normal results of three routine tests (blood, urine, stool) and C-reactive protein (CRP) level were randomly divided into two groups. The patients in prophylaxis group were given cephalothin V(2.0 g) intravenous 30 min before the operation, and the control group did not use any antibiotics. All the patients were injected with 6-10 ml ozone (40 microg/ml) for medical use into the discs with 21G needles under fluoroscopic guidance, followed by 10 ml ozone into the paravertebral space. Three days later the general examinations and CRP measurement were repeated.

RESULTSNo infection was found in these patients, nor were any significant differences noted in the results of the examinations between the two groups after controlling in patients with above-normal white blood cell count, neutrophil percentage and CRP level.

CONCLUSIONProphylaxis antibiotics is not necessary during the perioperative period of percutaneous intradiscal ozone injection for lumbar disc herniation.

Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Cefazolin ; therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Injections, Intralesional ; Intervertebral Disc Displacement ; diagnostic imaging ; drug therapy ; Lumbar Vertebrae ; Male ; Middle Aged ; Oxygen ; administration & dosage ; Ozone ; administration & dosage ; Perioperative Care ; Radiography

Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.
Adult ; Aged ; Amides/administration & dosage ; Anesthetics, Local/administration & dosage ; Anti-Inflammatory Agents/administration & dosage ; Cervical Vertebrae/*radiography ; Dexamethasone/administration & dosage ; Disability Evaluation ; Epidural Space/radiography ; Female ; Follow-Up Studies ; Humans ; Hyaluronoglucosaminidase/therapeutic use ; Injections, Epidural ; Intervertebral Disc Displacement/radiography/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain/drug therapy ; Pain/drug therapy ; Pain Measurement ; Questionnaires ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome