The Short-Term Outcome of Transforaminal Epidural Steroid Injection in Patients with Radicular Pain Due to Foraminal Stenosis from Lumbar Isthmic Spondylolisthesis

Gyu-Sik Choi,1 Mathieu Boudier-Revéret,2 Min Cheol Chang3 1Cheokbareun Rehabilitation Clinic, Pohang-si, Gyeonsangbuk-do, South Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada; 3Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email [email protected]: In this study, we evaluated the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in managing chronic radicular pain due to foraminal stenosis. Furthermore, we evaluated its effectiveness according to isthmic spondylolisthesis (IS) severity.Patients and Methods: We included 40 patients with radicular pain due to IS-derived foraminal stenosis in our study and treated them with TFESI. Two patients were lost during follow-up. Based on the lateral lumbar radiograph findings, we allocated the recruited patients with < 25% slippage by IS to Group 1 (n = 23) and those having 25– 50% slippage to Group 2 (n = 15). The degree of pain was measured using a numeric rating scale (NRS) at pre-treatment and 1 and 2 months after TFESI.Results: In 38 patients who completed the study, the NRS at pre-treatment was significantly reduced at the 1- and 2-month follow-ups. In the Group analysis, the NRS scores were significantly reduced after TFESI in both Groups 1 and 2, regardless of IS severity. However, the reduction in NRS scores 1 month after TFESI was significantly greater in Group 1 than in Group 2. Moreover, the rate of successful treatment outcomes was significantly higher (65.2%) in Group 1 than in Group 2 (26.7%).Conclusion: After TFESI, chronic radicular pain was significantly reduced regardless of IS severity, and its effect persisted for at least 2 months. However, its effect was superior when the vertebra slippage by IS was less than 25% compared to patients with 25%– 50%.Keywords: isthmic spondylolisthesis, foraminal spinal stenosis, lumbar spinal transforaminal epidural steroid injection, magnetic resonance imaging, corticosteroid

At Least 5-Year Outcomes of Whiplash-Induced Chronic Neck Pain Following Response to Intra-Articular Facet Joint Corticosteroid Injection

Seoyon Yang,1 Mathieu Boudier-Revéret,2 Ming-Yen Hsiao,3,4 Soyoung Kwak,5 Min Cheol Chang5 1Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Woman’s University School of Medicine, Seoul, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, Canada; 3Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan; 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; 5Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4682, Email [email protected]: To investigate whether the response to intra-articular facet joint corticosteroid injection can determine the long-term prognosis (at least 5 years after injury) of whiplash injury-related neck pain sustained 3– 12 months after injury.Methods: Of 65 patients who visited a university hospital for persistent whiplash injury-induced axial neck pain sustained 3– 12 months after injury (numeric rating scale score ≥ 3) and had received intra-articular facet joint corticosteroid injection, 40 completed the telephone interview. We divided the patients into “good response group” (≥ 50% pain reduction at 1 month after the injection) and “poor response group” (< 50% pain reduction at 1 month after the injection). We asked participants regarding the presence and degree of neck pain, its impact on work, and the use of oral pain medication or injection treatment.Results: A follow-up at least 5 years after the injury found that the number of patients with persistent whiplash injury-related neck pain was significantly lower in the good response group than in the poor response group. The number of patients taking oral pain medications prescribed by a medical doctor or receiving injection treatments in a pain clinic or hospital for neck pain was lower in the good response group than in the poor response group. The number of patients who answered that their work was affected by neck pain was lower in the good response group than in the poor response group.Conclusion: The response to intra-articular corticosteroid injection might be helpful in determining at least 5-year outcomes of chronic whiplash injury-induced pain.Keywords: whiplash injury, facet joint, corticosteroid, injection, neck pain, chronic pain, outcome, prognosi

Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study

Objectives To evaluate the effect of neurodynamics mobilization (NDM) on an artificially induced edema in the median nerve at the level of the carpal tunnel in unembalmed cadavers and to assess whether NDM tensioning techniques (TT) and NDM sliding techniques (SLT) induce similar effects on intraneural fluid dispersion. Design Fourteen upper extremities of seven unembalmed cadavers were used in this study. A biomimetic solution was injected directly under the epineurium of the median nerve at the level of the proximal transverse carpal ligament. The initial dye spread was allowed to stabilize and measured with a digital caliper. Tensioning and sliding techniques were applied following a randomized crossover design to each upper extremity and were performed for a total of 5 min each. Post-intervention dye spread measurements were taken after each technique. Results After the first mobilization, the mean longitudinal dye spread (7.5 ± 6.6 mm) was significantly greater (p = 0.024) compared to the stabilized dye spread. There was a significant longitudinal diffusion effect with both, TT (p = 0.018) and SLT (p = 0.016), with no statistically significant difference between techniques (p = 0.976). The order in which techniques were administered did not influence the diffusion. Conclusion Five minute of passive NDM in the form of tensioning or sliding technique induced significant fluid dispersion in the median nerve at the carpal tunnel of unembalmed human cadavers. This study provides support for clinical mechanism of NDM in reducing intraneural edema.SCOPUS: ar.jinfo:eu-repo/semantics/publishe