Online ISSN: 2515-8260

Keywords : Lumbar


DIAGNOSTIC UTILITY OF MRI FINDINGS COMPARED TO PER-OPERATIVE FINDINGS IN LUMBAR INTERVERTEBRAL DISC PROLAPSE PATIENTS

Dr. Venkata Sivaram G V, Dr. S.V.L.Narasimha Reddy,Dr Kolla Srinivas Yadav, Dr. Sridhar Jakkepally, Dr Roish Uddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1006-1013

Background: Diagnosis of syndromes related to lumbar spine has improved with use of magnetic resonance imaging (MRI). Neurological signs of herniated lumbar disc are important to make a decision whether to operate the patient or not. Hence, clinical examination is also important in patients with herniated lumbar disc.
Objective: To study diagnostic utility of MRI findings compared to per-operative findings in Lumbar intervertebral disc prolapse patients
Methods: Hospital based diagnostic evaluation study was carried out among 30 patients having signs and symptoms of herniated lumbar disc. All the consecutive patients presenting with low back ache (LBA) and sciatica admitted were thoroughly examined. Neurological examination, X-ray Lumbar Spine AP and lateral, MRI were done. MRI lumbar spine was graded as per Michigan scale. Surgery was done electively under general anesthesia in prone position. Patients were followed to assess the pain.
Results: Both MRI and per-operative findings agreed on the actual finding of zone of disc prolapse in 24 (80%) of the cases and differed in remaining six (20%) of the cases. The sensitivity of MRI compared to per-operative finding in diagnosing central zone of disc prolapse was 84.6% of cases and 76.5% in diagnosing lateral zone of disc prolapse. The outcome of surgery was excellent in 43.3% of cases followed by fair in 50% of the cases. It was poor in only two cases.
Conclusion: Subjects in the age groups 40-59 years were commonly affected MRI is a very sensitive in detecting symptomatic lumbar disc prolapse

Clinical Effectiveness Of “Transforaminal Epidural Block”by Subpedicular Approach In Lumbar Radiculopathy

Dr.Santosh Kumar Sahu; Dr.Deepak Verma; Dr.Binod Chandra Raulo

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 963-971

Introduction :TFEB(Transforaminal Epidural Block) involves delivery of drugs through the epidural space and along the nerve root.’’This procedure can be both diagnostic (to know whether the given nerve root is the cause of pain) and therapeutic (to lessen pain by deceasing irritation around the nerve root) purposes’’. The subpedicular approach is a very commonly used procedure at present. This technique involves placement of the spinal needle in‘’the secure triangle under the inferior exterior of the pedicle to reach the superolateral spinal nerve responsible for pain generation’’.‘’Transforaminal area is the favoured location,as the drugs can be directly ‘’delivered into the anterior extradural space, i.e. area stuck between the back of the protruded disc and the anterior nerve root dural sleeve,thus reducing the risk of injuy to dura mater’’. Transforaminal Epidural Block injections reduces the inflammation andstabilizes the nociceptive neural activity thus relieving the pain.
Materials and methods :We conducted aProspective Cohort Study at IMS&SUM hospital,Bhubaneswar from Mach 2017 to December 2019.Our study includes 100 patients with lower back ache with radiculopathy due to disc herniation or lumbar canal stenosis managed conservatively for at least six weeks.All the patients have been diagnosed with transforaminal epidural block(TFEB). A complete clinical examination was done to rule out other causes of lowbachache with radiculopathy. Patient having predominant unilateral symptoms were given transforaminal block.
Results :. In our study 78 patients (78 %) had significant pain relief,which common in 48 patients(48%) till the go behind up period of more than 12 months,78 patients(78%)till the follow up period of 6months .The current study also provides evidence that, LTFEB provides significant respite of pain in majority of patients for three months following the block’’. Reduction in pain was assessed by‘’restoration of activities of daily life without the need for other treatment modalities’’.48% of patients who were administered LTFEB had relief that persists for more than 12 months, without need for any other treatment.
Conclusion : From our study we conclude that, LTFEBs are reliable and cost effective procedures, without major adverse effects. Irrespective of become old, gender, stage of injection, symptom period and harshness of pain, TFEBs can provide significant relief of pain in majority of patients.