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KMID : 1195520140070010033
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Journal of Korean Orthopaedic Ultrasound Society
2014 Volume.7 No. 1 p.33 ~ p.38
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Benefit of Ultrasound-guided Therapeutic Medial Branch Blocks after Percutaneous Epidural Neuroplasty
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Moon Sang-Ho
Lee Song
Jung Jae-Hyun
Shin Won-Shik
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Abstract
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Purpose: To determine the therapeutic effectiveness of ultrasound-guided medial branch block (MBB) for the herniated lumbar disc patients who did not relieve their symptoms after percutaneous epidural neuroplasty (PEN).
Materials and Methods: From August 2011 to February 2013, 559 patients with herniated lumbar disc have undergone PEN. Among them, ultrasound-guided MBBs were performed for the patients who had sustained low back pain and refered pain to lower extremities. Eighty eight patients were followed at 1 month and 39 patients could be followed at 6 month. All procedures have been performed by the one operator, and 23 G, 10 cm needle was placed and 0.5% lidocaine was injected under ultrasound guide. To target medial branches from L1 to L5, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at each follow-up. Significant pain relief was described as a 50% or more reduction in VAS and significant improvement in function was described as at least a 40% reduction in ODI.
Results: VAS showed that preprocedure pain (7.35±1.68; mean±SD) significantly decreased 1 month after block (3.36 ±2.98) and 6 month (3.05±2.27) (p<0.05). ODI also showed that preprocedure score (32.82±8.77) significantly decreased at 1 month (15.14±14.01) and 6 month (12.97±8.82) (p<0.05). Significant pain relief was observed in 64.49% at 1 month and 64.10% at 6 month. Significant functional improvement in 59.81% at 1 month and 61.54% at 6 month.
Conclusion: Ultrasound-guided medial branch block may sufficiently treat the facet problems secondary from disc disease.
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KEYWORD
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Herniated disc, Facet joint, Neuroplasty, Medial branch block, Ultrasound
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