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KMID : 0438219770140010091
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Korea University Medical Journal
1977 Volume.14 No. 1 p.91 ~ p.115
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New Method of Conservative Treatment of Low Back Pain
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朴相元/Park, Sang Won
李弘鍵/Lee, Hong Kun
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Abstract
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Low back pain with or without sciatica is usually one of the most incapacitating and certainly one of the most enigmatic problems in terms of etiology, diagnosis and pertinent therapy. Most of the low back pain with or without sciatica is supposed to be discogenic in its etiology; either in forms of degenerative change or protrusion of intervertebral disc.
Surgical procedures for these discogenic. low back pain have widely performed for decades. The results, however, have not always been satisfactory due to recurrence, extensive scarring of the nerve roots following surgery or a prolonged period of rehabilitation even if the operation is succesful.
On the other hand, conventional conservative treatment also does not always give good results. In this. connection, new methods of conservative treatment have been sought by many investigators. There are two approaches to the non-surgical treatment, one aiming to eliminate the etiologic mechanism and the other to treat the secondary radiculopathy which results from the primary mechanism. One of the former approaches, e.g. chemonucleolysis has commanded considerable attention but has been abandonded recently due to its frequent complications.
The latter approaches are infiltration of steroids combined with or without local anesthetics into the involved nerve root by means of either epidural, intrathecal or intervertebral nerve root injection. Clinical effect of these procedures, however, has not been completely clarified.
On the basis of the above facts the author has followed new forms of conservative treatment, e.g. by means of either intervertebral nerve root injection (60 patients) or epidural injection (40 patients) . in 100 patients, and tried to clarify the effect of the treatment and interrelationship between clinical effect and various clinical symptoms. The author used Winnie and Kirkaldy´s assesment score for the evaluation of the results.
The results are as follows:
1. Of 60 patients with intervertebral nerve root injection: good result in 41 patients (68.3%), fair in 8(13.3%) and poor in 11(18.4%) Of 40 patients with epidural injection; good result in 29 patients (72.5%), fair in 6(15%) and poor in 5(12.5%).
2. The age, sex, duration of symptom, mode of onset and trauma does not significantly influence the end results in both groups.
3. In the intervertebral nerve root injection group, patients with only low back pain, absence of limited back motion and straight leg raising test above 70 appear to have better prognosis. In the epidural injection group, patients with only low back pain or sciatica, absence of limited back motion and straight leg raising test above 30 appear to have better prognosis.
4. With the intervertebral nerve root injection, good results were observed in 14 cases (82.3%) out of 17 patients with degenerative spondylosis, 21 cases (70%) out of 30 patients with degenerative disc, and 6 cases (46.2%) out of 13 patiens with herniated disc. With the epidural injection, good results were observed in 13 cases (86.6%) out of 15 patients with degenerative spondylosis, 12 cases (70.6%) out of 17 patients with degenerative disc, and 4 cases(50%) out of 8 patients with herniated disc.
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