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Epidural injection of methylprednisolone with levobupivacaine under CT guidance improve radicular pain in herniated disc versus spinal stenosis

Introduction Epidural injections are commonly used for the treatment of low back pain in patients in whom conservative management has failed and who may wish to avoid surgery. Computed tomography guidance allows lumbar epidural injection to be performed rapidly, while allowing precise needle placement and proper placement of steroids near the pathologically inflamed nerve roots. Patients and Methods A total of 40 patients with chronic persistent lumbar radicular pain were allocated into two groups (20 patients each). The disc herniation (DH) group and the spinal stenosis (SS) group, each received a mixture of 40 mg of methylprednisolone plus 25 mg of 0.5% levobupivacaine+4 ml of saline 0.9% (both in a 10 ml syringe) through a paramedian interlaminar lumbar epidural injection. The visual analogue scale (VAS) was used, where 0 = no pain and 10 = the worst pain imaginable. The patient satisfaction scale (excellent, good, poor, bad) was assessed before injection, after 24 h, and 2 weeks, 3, and 6 months from injection; the need for repeated injection at less than 3 months and adverse events were also recorded. Results There was a significant reduction in the VAS score at 24 h (group DH 4.3 ± 1.5 VS. group SS 5.8 ± 2.4) (P < 0.05) and 2 weeks after injection; patients in group DH had a significantly lower VAS score (3.2 ± 1.6) in relation to group SS (5.2 ± 1.5) (P<0.05), but there was highly significant reduction in VAS at 3 and 6 months in the DH group (2.4 ± 1.4, 1.6 ± 1.2) compared with the SS group (4.6 ± 1.5, 4.9 ± 2.4) (P <0.01). Repeated injections at less than 3 months were lesser in the DH group (20%) than in the SS group (55%) (P < 0.01). The patient satisfaction scale was significantly increased in group DH compared with group SS (P < 0.001), with no major adverse events in the DH group compared with the SS group (P < 0.01). Conclusion An interlaminar lumbar epidural injection of methylprednisiolone with levobupivacaine under computed tomography guidance provided effective pain relief in the herniated disc group compared with the SS group, because it was safe, simple, and more accurate.