الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Affecting all age groups, chronic low back pain (LBP) with or without radiculopathy is one of the main the causes of disability and one of the most frequently reported symptoms. Reducing pain, improving function, and preventing recurrence are the primary goals in the treatment of patients with LBP. Although medical treatment is the first line of management in most cases, interventional therapy is considered once conservative management has failed. Appropriate and effective treatment of chronic LBP with or without lumbar radiculopathy requires a precise diagnostic tool in order to target pain generators. By diagnosing the origin of the pain, the clinician can therefore provide appropriate therapy for recurrent and disabling low back pain and or lumbar radiculopathy due to the degenerative disease, and thus identify the level for surgery.
The aim of this study was to determine the predictive value of diagnostic spinal injections in surgical outcome in patients with chronic LBP and lumbar radiculopathy.
This study included 30 patients complaining of chronic low back pain and/or lumbar radiculopathy admitted to the Spine unit/Neurosurgery Department of Alexandria Main University Hospital during the period from May 2021 to July 2022, and who underwent lumbar spine surgery following positive lumbar spine diagnostic injections.
The preoperative assessment consisted of a general neurological examination, evaluation of the Oswestry disability index (ODI), and a visual analog scale (VAS). Radiological studies were performed for each patient consisting of lumbosacral MRI, and lumbosacral X ray (AP, lateral, and dynamic standing views).
Provocative discography and/or selective root injection were performed preoperatively for each patient based on clinical and radiological characteristics. All patients were followed for a short period with immediate, one-month and at least three months post-surgery assessments as follows: complete general and neurological examination, Oswestry disability index, visual analog scale.
There were 46.7% female patients with mean age of 42.60 ± 8.27 years in whole sample. The mean duration of symptoms was 22.33 ± 20.78 months ranged from 4.0 to 60.0 months.
The VAS decreased significantly from preoperative mean value of 8.26 ± 0.79 to postoperative mean value of 1.97 ± 0.92; with almost two-thirds of the patients experienced more than 75% pain reduction. Eighty percent patients had a favorable outcome regarding the improvement of pain intensity with a postoperative visual analogue scale of less than three.
The functional outcome was favorable for two-thirds of patients with a postoperative ODI less than or equal to 10. In addition, the ODI decreased significantly from preoperative mean value of 34.13 ± 4.88 to 11.47 ± 3.36 after surgery in the whole sample. The majority of patients had a reduction in ODI greater than or equal to 50%.
There was no statistically significant difference in the mean postoperative VAS and in the mean postoperative ODI regarding to the type of surgery. Differences in mean postoperative VAS and ODI between patients tested positive for one diagnostic injection and those with both positive diagnostic injections were not statistically significant.
The post-selective nerve root block VAS was significantly correlated to the postoperative visual analogue scale, percent improvement in pain and postoperative reduction in ODI; while the postoperative ODI was not significantly associated with the post-selective nerve root block VAS.