| 제목 |
Intradiscal Steroids Injection and Spinal Stabilization Exercise for Lumbosacral Discogenic Pain |
| 소속 |
Korea University Anam Hospital, Department of Rehabilitation Medicine1, Severance Hospital, Department of Rehabilitation Medicine2, Korea University Ansan Hospital, Department of Rehabilitation Medicine3 |
| 저자 |
Soon Woo Kwon1*, Dahn Kim2, Sang-Heon Lee1, Nack Hwan Kim3† |
Introduction: Chronic lumbosacral discogenic pain (CLDP) is low back pain originating from damaged intervertebral disc. The consensus for treatment of CLDP has not been established firmly. Non-operative treatments such as intradiscal steroid injections (ISI) and spinal stabilization exercise are likely to be the initial treatment strategy.
Objective: To evaluate the effectiveness of ISI and spinal stabilization exercise in the treatment of CLDP and investigate its clinical significance.
Method: A total of 131 patients whom underwent the provocative discography and diagnosed as CLDP were restrospectively enrolled in this study. Numerical rating scale (NRS) scores at baseline and at 1 week, 1 month, 3 months and 6 months after ISIs were retrieved and the patients were divided into two groups based on the pain response (ISI-response group: NRS reduction more than 50%) at 1 week after ISI. The two groups were sub-grouped by spinal stabilization exercise and effect of exercise on CLDP was analyzed. Repeated-measures analysis of variance (ANOVA) was used to analyze change in pain over time. Multiple linear regression analysis was used to identify the independent factors influencing pain intensity at 6 months after the ISI.
Result: 75 patients were categorized into ISI-response group and 56 patients were categorized into ISI-no response group. Both the groups showed significant NRS score reduction during the 6-month follow-up period (p<0.001). However, the therapeutic effect of spinal stabilization exercise was only noted in the ISI-no response group. Different NRS score reduction patterns were noted in the exercise group (p=0.034) and significant pain reduction at 6 months after the ISI (p=0.009, Figure 1.). In the regression analysis, pain duration (p=0.008), NRS score change in 1 week after the ISI (p<0.001) and the amount of the spinal stabilization exercise (p=0.007) were revealed to be associated with pain reduction at 6 months after the ISI. (Table 1.)
Discussion: ISI appear to be an effective treatment option for CLDP with the pain reduction lasting during the 6 months study period, regardless of the subgroups. And the spinal stabilization exercise can also be a promising treatment for CLDP as it showed relevance in the pain reduction in the patients whom the immediate pain reduction of the ISI was relatively inapparent.
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Figure 1. Numerical rating scale (NRS) pain score change over time in the Injection-No response group. The error bars represent 95% confidential interval. The patients of both Exercise and Observation subgroups experienced pain improvements over time for 6 months. At 6 months, however, the Exercise subgroup patients demonstrated significantly lower NRS scores than Observation subgroup patients (p = 0.009).
Table 1. Factors affecting pain reduction after ISI.
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