COMPARATIVE STUDY OF MANAGEMENT OF LOW BACK ACHE WITH LUMBAR EPIDURAL BLOCK, CAUDAL BLOCK, FACETAL BLOCK
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Keywords
Lumbar Epidural Block, Caudal Block, Facetal Block,, Low Backache.
Abstract
BACKGROUND: Several approaches are available to access the epidural space, namely, interlaminar, transforaminal and caudal. Despite the fact that all three techniques provide medicine into the epidural area, these methods differ significantly from one another. This study was carried out to assess the effectiveness of LEB (Lumbar Epidural Block) (interlaminar approach), CB (Caudal Block) (caudal approach), and FB (Facetal Block) (lumbar facet intrarticular injection).
MATERIALS AND METHODS: This was a prospective study involving 120 patients with LBA (Low Back Ache) for more than 6 weeks with evidence of lumbar disc herniation on MRI and failed conservative management. The patients were followed at 1st month, 2nd month, 3rd month, 6th month, one year and one and half years by VAS, ODI, SLRT and SF 36 scores.
RESULTS: The mean VAS was significantly lower in the facetal block and caudal block groups compared to the lumbar epidural block at 3 and 6 months follow-up (p = 0.015 and 0.001 respectively). However, there was no difference in the scores at other follow-ups. The mean ODI was significantly lower in the facetal block and caudal block groups compared to the lumbar epidural block at 2 and 6 months follow-up (p = 0.000 and 0.015 respectively). However, there was no difference in the scores at other follow-ups. The mean SLRT was significantly lower in the facetal block and caudal block groups compared to the lumbar epidural block at 2, 3 and 6 months of follow-up (p = 0.000 and 0.015 respectively). However, there was no difference in the scores at other follow-ups. There was no difference in the SF36 scores between the groups at follow-ups.
CONCLUSION: All three approaches-lumbar epidural block, caudal block, and facetal block—are effective in the management of chronic low backache, as evidenced by the reduction in the VAS, ODI, and SF 36 scores and the low incidence of complications. Although in the short term, caudal block and facetal block had better scores, on long-term follow-up, there was no difference between the three approaches.
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Dr. G. Raviteja
Associate Professor, Department of Orthopaedics, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India.
Dr. Cheekati Lalki Sai Kumar
Assistant Professor, Department of Orthopaedics, Mamata Medical College, Khammam, Telangana, India.
Dr. Tammali Santhosh Kumar
Senior Resident, Department of Orthopaedics, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India.
Dr. Takkallapalli Dushyanthrao
Assistant Professor, Department of Orthopaedics, Mamata Medical College, Khammam, Telangana, India.
Dr. Mohammed Abdul Bari
Professor, Department of Orthopaedics, Deccan College of Medical Sciences, Hyderabad, Telangana, India.