Опубликована: Фев. 21, 2024
The lumbosacral radicular syndrome or sciatica is a common neurological problem characterized by pain radiating into the leg, following one of nerve roots. There are several treatment options including medication, physiotherapy, transforaminal epidural steroid injections (TESIs) and disc surgery. This thesis, that was aimed to contribute best clinical practice during acute stage subdivided three themes. Theme 1: Diagnosis theme contains an historical overview survey among 124 physicians. results this showed 40-60% neurologists think TESIs effective in 40% injected patients 23/44(52%) anesthesiologists 60-80% patients. We also found treat with initially medication followed referral for surgery Anesthesiologists more may perform selective root block. 2: Inflammation contained systematic review answers two questions: What inflammatory biomarkers have been identified literature so far, there association between level activity symptoms? Based on review, we concluded considerable heterogeneity type measurements included studies that, taking account overall risk bias, insufficient evidence draw firm conclusions regarding relationship inflammation symptoms sciatica. 3 (Cost-)effectiveness described design, statistical analysis plan, STAR-trial. A total 141 (due herniated disc) included. Participants were randomly assigned to: 1) usual care TESI 1ml 40mg/ml Methylprednisolone plus 0.5% Levobupivacaine (intervention 1); 2) injection 1 ml NaCl 0.9% 2); 3) care, consisting oral without physiotherapy (control). Co-primary outcomes back leg intensity, physical functioning, recovery measured 6-month follow-up. Secondary health-related quality life, patient satisfaction, rate. no significant mean differences co-primary groups follow-up, except (a not clinically relevant difference) when comparing intervention group control (-0.96 95%CI:-1.83 -0.09). For secondary outcomes, some satisfaction surgery, but only 2 control. serious side effects. these results, do recommend as standard treatment. Nonetheless, seem be associated less opioid use. After 6 months, costs found. adjusted difference societal €1718 (95%CI:-3020 6052) comparison (intervention-group versus group), €1640 (95%CI:- 3354 6106) intervention-group €770 (95%CI: -3758 5702) control). maximum probability interventions being cost-effective compared low (<0.7) all effect measures. These suggest adding (or TEI)
Язык: Английский