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ORIJINAL ARAŞTIRMA

Nöral Foramen ve İntervertebral Diskin Morfolojik Özelliklerinin Transforaminal Epidural Steroid Enjeksiyonunun Başarısına Etkisi: Gözlemsel Bir Çalışma
The Association Between Morphometric Features of Neural Foramen and Intervertebral Disc and Treatment Success of Lumbar Transforaminal Epidural Steroid Injection: An Observational Study
Received Date : 03 Mar 2023
Accepted Date : 13 Jun 2023
Available Online : 16 Jun 2023
Doi: 10.31609/jpmrs.2023-96465 - Makale Dili: EN
J PMR Sci. 2023;26(3):257-63
ÖZET
Amaç: Bu çalışmanın amacı, nöral foramen ve intervertebral diskin manyetik rezonans görüntülemede (MRG) değerlendirilen morfometrik özelliklerinin transforaminal epidural steroid enjeksiyonunun başarısına etkisini araştırmaktır. Epidural steroid enjeksiyonundan sonra tedavi başarısını öngören birkaç klinik ve radyolojik özellik öne sürülmüştür. Bununla birlikte ilgili nöral foramenlerin morfometrik özelliklerinin transforaminal epidural steroid enjeksiyonuna verilen cevaba etkisi bilinmemektedir. Gereç ve Yöntemler: Bu çalışma, prospektif olarak tek taraflı L5 sinir köküne transforaminal epidural steroid enjeksiyonu uygulanan 45 hastanın katılımıyla gerçekleştirildi. Ağrı şiddeti, dizabilite ve depresyon düzeyleri başlangıçta, 3. hafta ve 3. ayda değerlendirildi. İlgili nöral foramen ve intervertebral diskin morfometrileri sagittal MRG taramalarında değerlendirildi ve tedaviye yanıt veren ve yanıt vermeyen hastalar arasında karşılaştırıldı. Bulgular: Nöral foramen ve intervertebral diskin yapılan tüm morfometrik ölçümlerinin iki değerlendirici' arası güvenilirliği yüksek veya mükemmeldi. Ağrı, depresyon ve dizabilite skorları başlangıca göre 3. ayda önemli ölçüde iyileşti. Morfometrik değerlendirme açısından yanıt verenler ve yanıt vermeyenler arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Sonuç: Bu çalışmanın sonuçları, disk yüksekliği, pedikül uzunluğu, minimum ve maksimum foraminal genişlik, foraminal kesit alanı, sinir kökü kesit alanı gibi MRG tabanlı morfometrik parametrelerin transforaminal epidural steroid enjeksiyonu etkinliği üzerinde bir etkisi olmadığını göstermektedir.
ABSTRACT
Objective: To investigate the impact of morphometric characteristics of neural foramen (NF) and intervertebral disc (ID) on magnetic resonance imaging (MRI) to the treatment outcomes after transforaminal epidural steroid injection (TFESI). Few clinical and radiological features are suggested predicting treatment success after epidural steroid injection. However, the impact of morphometric characteristics of the relevant NF to the response to TFESI is unknown. Material and Methods: This study was carried out prospectively with the participation of 45 patients who were treated with single level TFESI to L5 nerve root. Pain intensity, disability, and depression levels were assessed at baseline, 3rd week and 3rd month. The morphometrics of the relevant NF and ID were evaluated on sagittal MRI scans and compared between patients who responded and did not respond to the treatment. Results: The interrater reliability of all morphometric measurements of NF and ID performed by 2 physicians were high or excellent. Pain, depression, and disability scores were improved significantly at 3rd month compared to baseline. No statistically significant difference was found between responders and non-responders regarding morphometric evaluation (p>0.05). Conclusion: The results of the present study indicate that MRI based morphometric parameters like disc height, pedicle length, minimum and maximum foraminal width, foraminal cross-sectional area (CSA), nerve root CSA have no effect on the efficacy of TFESI.
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