Kondrashov O. Epidural steroid introduction in treatment of lumbar spine discogenic pain syndrome.

The aim of the study was to develop a method of treatment of lumbar spine discogenic pain syndrome, using epidural injections of local anesthetic bupivacaine and long-acting steroid betamethasone, and to identify differentiated indications for surgical treatment. The results of treatment of 186 patients with lumbar spine discogenic pain and radicular symptoms were studied. The patients were divided into 3 groups: patients with central and paramedial itravertebral hernias; patients with central and paramedial hernias complicated by sequestration; patients with foraminal hernias. Epidural injections of bupivacaine and bupivacaine, combined with betamethasone, were made in all groups of patients. Therapy effectiveness was evaluated by pain intensity measuring according to Visual Analogue Scale (VAS), patients' functional status was assessed using Oswestry Disability Index (ODI), patients' ability to work and analgesic doses, been required, also were took into consideration. The considerable diminishing of pain intensity and functional state improvement were marked in all groups of patients. However efficiency of epidural introduction of bupivacaine and bupivacaine was insufficient, these patients were operated. Taking into consideration bupivacaine and betamethasone pharmacological properties one can say definitely that the pain syndrome and radicular symptoms in most of patients with lumbar discogenic pain were caused by edema in epidural space, which was effectively treated by these drugs. In patients with pain syndrome, caused by nerve structures compression with hernia tissue, epidural bupivacaine and betamethasone introduction was uneffective, these patients need operation.