Pain Improvement Among Chronic Lumbar Disc Herniation Patients Underwent Epidural Triamcinolone With Or Without Hyaluronidase Injection Within 3 Months Of Follow-Up: A Prospective Study

Authors

  • Trianggoro Budisulistyo Department of Neurology Faculty of Medicine Diponegoro University/ Dr. Kariadi Hospital Semarang- Indonesia, Indonesia
  • Amin Husni Department of Neurology Faculty of Medicine Diponegoro University/ Dr. Kariadi Hospital Semarang- Indonesia, Indonesia
  • Dodik Tugasworo Department of Neurology Faculty of Medicine Diponegoro University/ Dr. Kariadi Hospital Semarang- Indonesia, Indonesia
  • Dwi Pudjonarko Department of Neurology Faculty of Medicine Diponegoro University/ Dr. Kariadi Hospital Semarang- Indonesia, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v10i1.850

Keywords:

CLDH, nerve compression, fibrosis, pain, triamcinolone, hyaluronidase, epidural injection

Abstract

Background

Chronic lumbar disc herniation (CLDH) will accompany by chronic inflammation, so the fibrosis tissues formed in the epidural space and adjacent nerve roots, and lead to mixed pain syndrome.

Objectives

To compare between triamcinolone only and hyaluronidase 1500 international unit (IU) administration epidural injection for treating bulged or protrusion CLDH.    

Methods

This prospective study involved CLDH patients visiting the outpatient department of Neurology at Dr. Kariadi Hospital Semarang Indonesia from November 2021 until August 2022. They divided: triamcinolone (Group 1) and hyaluronidase 1500 IU and triamcinolone epidural injection (Group 2) with 3 days of hospitalization. Neurotrophic was prescribed during 3 months of follow-up and ordered for personal physical treatment. They analyzed pain improvements (NRS and Pain DETECT), and the Oswestry Disability Index (ODI) scores.

Results

The 37 subjects were recruited but 1 female dropped out cause of re-injection, so 13 males and 23 females aged between 24 to 72 years old (mean 48+2) were followed. They significantly improved (Wilcoxon test p=.000), as the NRS score was 47.9% (Group 1) and 55.4% (Group 2). ODI scores without significance (Mann-Whitney p> .005), such at 2 weeks (group 1= 20.4%, group 2= 23.6%) and 3 months (group 1= 58.1%, group 2= 53.7%). They observed nociceptive and neuropathic improvement even though needed more time for the healing process.

Conclussions

This study proved hyaluronidase administration before triamcinolone epidural injection with better improvements for treating bulged or protrusion CLDH patients.

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References

  1. Fronza M, Muhr C, da Silveira DSC, Sorgi CA, de Paula Rodrigues SF, Farsky SHP, et al. 2016. “Hyaluronidase decreases neutrophils infiltration to the inflammatory site”. Res 65(7):533-542. Retrieved (https://doi.org/10.1007/s00011-016-0935-0).
  2. El Tayeb MAO. 2015. “Value of Hyaluronidase in Steroid Caudal Epidural Injection with High Volume Normal Saline for Failed Back Syndrome”. Egyptian Journal of Neurosurgery 30 (3):233-236.
  3. Trescot AM, Chopra P, Abdi S, Datta S, Schultz DM. 2007. “Systemic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update”. Pain Physician 10:129–146.
  4. Manchikanti L, Singh V, Cash KA, Pampati V. 2012. “Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial”. J Pain Res 5:597-608.
  5. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL. 2007. “Epidural steroids in the management of chronic spinal pain: A systematic review”. Pain Physician 10:185-212.
  6. Heavner JE, Racz GB, Raj P. 1999. “Percutaneous epidural neuroplasty: prospective evaluation of 0.9%NaCl versus 10% NaCl with or without hyaluronidase”. Reg Anesth Pain Med 24:202–207.
  7. Cosamalón-Gana I, Cosamalón-Gana T, Mattos-Piaggio G, Villar-Suárezc V, García-Cosamalónc J, Vega-Álvarez JA. 2020. “Inflammation in the intervertebral disc herniation”. Neurocirugia 32(1):21-35. Retrieved (https://doi.org/10.1016/j.neucie.2020.04.00).
  8. Amin RM, Andrade NS, Neuman BJ. 2017. “Lumbar Disc Herniation”. Curr Rev Musculoskelet Med 10: 507–516. Retrieved (https://doi.org/10.1007/s12178-017-9441-4).
  9. Kim SB, Lee KW, Lee JH, Kim MA, Kim BH. 2011. “The additional effect of hyaluronidase in lumbar interlaminar epidural injection”. Ann Rehabil Med 35: 405-411.
  10. Kulkarni K R, Talakanti S K. 2014. “Management of failed back surgery syndrome with transforaminal epidural steroid and epidural saline adhesiolysis”. Indian Journal of Pain 28:117-120.
  11. Iversen T, Solberg TK, Romner B, Wilsgaard T, Twisk J, Anke A, et al. 2011. “Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial”. BMJ 343;1-15. Retrieved (https://doi.org/10.1136/bmj.d5278).
  12. T Bendinger, N Plunkett. 2016. “Measurement in pain medicine.” BJA Education 16 (9): 310–315. Retrieved (https://doi.org/10.1093/bjaed/mkw014)
  13. Cruccu G, Truini A. 2009. “Tools for Assessing Neuropathic Pain”. PLoS Med 6(4): 1-5. Retrieved (https://doi.org/10.1371/journal.pmed.1000045)
  14. Leonardi, M, Boos, N. 2008. Spinal Disorders Fundamentals of Diagnosis and Treatment, First Edition.
  15. Pereira P, Avelino A, Monteiro P, Vaz R, Lopes MC. 2014. “New Insights from Immunohistochemistry for the Characterization of Epidural Scar Tissue”. Pain Physician. 17:465-74
  16. Sae-Jung S, Jirarattanaphochai K, Sumananont C, Wittayapairoj K, Sukhonthamarn K. 2015. “Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model”. Asian Spine J 9(4):587-594.
  17. Gabor D, Carl E. 2014. Pain and treatment, First Edition.
  18. Ma D, Liang Y, Wang D, Liu Z, Zhang W, Ma T, et al. 2013. “Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly”. Clinical Interventions in Aging 8:1047–1050. Retrieved (http://dx.doi.org/10.2147/CIA.S49698)
  19. Khorami A, Oliveira C, Maher C, Bindels P, Machado G, Pinto R, et al. 2021. “Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines”. Clin. Med 10(11): 1-21.
  20. Sany S, Shahriar M, Nyme Z, Tanjim T. 2021. “Effectiveness of strengthening exercise plus activities of daily living instructions in reducing pain in patients with lumbar disc herniation: a randomized controlled trial”. F1000 Research 10:1-14. Retrieved (https://doi.org/10.12688/f1000research.74232.1)
  21. Yang X, Wei X, Mu Y, Li Q, Liu J. 2020. “A review of the mechanism of the central analgesic effect of lidocaine”. Medicine 99(17):1-4. Retrieved (http://dx.doi.org/10.1097/MD.0000000000019898)
  22. Patel R, Montagut B, Dickenson A. 2018. “Calcium channel modulation as a target in chronic pain control”. British Journal of Pharmacology 175: 2173–2284. Retrieved (https://doi.org/10.1111/bph.13789)
  23. Karnina R, Arif S, Hatta M, Bukhari A. 2021. “Molecular mechanisms of lidocaine”. Annals of Medicine and Surgery 69: 1-8. Retrieved (https://doi.org/10.1016/j.amsu.2021.102733)
  24. Ko S, Vaccaro A, Chang H, Shin D. 2015. “An Evaluation of the Effectiveness of Hyaluronidase in the Selective Nerve Root Block of Radiculopathy: A Double Blind, Controlled Clinical Trial”. Asian Spine Journal 9(1): 83-89. Retrieved (https://doi.org/10.4184/asj.2015.9.1.83)
  25. Tomkins L, Conway J, Hepler C, Haig A. 2012. “Changes in Objectively Measured Physical Activity (Performance) After Epidural Steroid Injection for Lumbar Spinal Stenosis”. Arch Phys Med Rehabil 93(11):2008-2014. Retrieved (http://dx.doi.org/10.1016/j.apmr.2012.05.014)
  26. Kennedy D, Plastaras C, Casey E, Visco C, Rittenberg J, Conrad B, Sigler J, et al. 2014. “Comparative Effectiveness of Lumbar Transforaminal Epidural Steroid Injections with Particulate Versus Nonparticulate Corticosteroids for Lumbar Radicular Pain due to Intervertebral Disc Herniation: A Prospective, Randomized, Double-Blind Trial”. Pain Medicine 15: 548–555
  27. Finnerup N, Kuner R, Jensen T. 2020. “Neuropathic Pain: From Mechanisms To Treatment”. Physiol Rev. 101: 259–301. Retrieved (https://doi.org/10.1152/physrev.00045.2019)
  28. Park C, Lee S. 2022. “Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study”. AIMS Neuroscience 9(1): 24–30. Retrieved (https://doi.org/10.3934/Neuroscience.2022003)

Additional Files

Published

2023-03-31

How to Cite

1.
Budisulistyo T, Husni A, Tugasworo D, Pudjonarko D. Pain Improvement Among Chronic Lumbar Disc Herniation Patients Underwent Epidural Triamcinolone With Or Without Hyaluronidase Injection Within 3 Months Of Follow-Up: A Prospective Study. Medica Hospitalia J. Clin. Med. [Internet]. 2023 Mar. 31 [cited 2024 Dec. 26];10(1):44-51. Available from: http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/850

Issue

Vol. 10 No. 1 (2023): Med Hosp; March 2023

Section

Original Article

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