Ultrasound Versus Fluoroscopic-Controlled Analgesic Epidural Blockade in Patients with Degenerative Diseases of the Spine. Summary of the Doctoral Thesis

Abstract

Thesis “Ultrasound versus fluoroscopic-controlled analgesic epidural blockade in patients with degenerative diseases of the spine” dedicated to the comparative analysis of quality and effectiveness of the procedure. Epidural steroid injections have been used for treatment of lower back pain and irradiate pain in the legs for many years. Steroids are entered into the epidural space at the target intervertebral level in order to achieve the right level of pathological changes to reduce the inflammatory process and pain. Present Practice Guidelines for Chronic Pain Management suggest that the procedure should be performed with appropriate fluoroscopic image guidance to confirm correct site of pathology and epidural space. In Latvia fluoroscopic-controlled epidural blockade is carried out only in a few specialized pain rooms, but in most cases blockades are performed based on anatomical landmarks without application of visualization technique. This fact can be explained by fluoroscopic equipment costs, unavailability and the radiation risk during the procedure. In the past 5 years ultrasonography has been increasingly used in the field of regional anesthesia as visualization technique, to facilitate spinal and epidural anesthesia performance and avoid fluoroscopic control risks. However, the application of the ultrasonography in chronic pain management is still in the development stage. The aim of the study was to show that ultrasound is equivalent visualization method to fluoroscopy for epidural blockades in patients with low back pain secondary to degenerative spine diseases. Our study for the first time in Latvia epidural block was performed after spinal ultrasound visualization. The current study was designed to evaluate procedure accuracy, technical difficulty, and analgesic and functional improvements of ultrasound-assisted interlaminar epidural steroid injections in comparison to fluoroscopy-guided injection, as well as researched side effects and complications. The study have shown that blockade performed after ultrasound spine visualization can achieve equivalent analgesia and functional disability reduction effect compared with the clinical efficacy of the traditional fluoroscopic-controlled blocks (“gold” standard in pain medicine) in patients with low back pain. To summarize, the research data shows that epidural blockade efficiency and performance characteristics are dependent on patient demographics, physical and clinical parameters. Procedure outcomes dependent of the patient’s age, body mass index, numbers of morphological changes in spine, and other clinical indicators such as pain intensity, degree of functional disability index and back pain duration. The results of this study demonstrate that the ultrasound-assisted can be an alternative to fluoroscopic controlled epidural injections method, if the patient is allergic to contrast, fluoroscopy is contraindicated or not available.