[Angle of needle position for the epidural-perineural injection at the lumbar spine]

Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy

Lumbar radiculopathy is one of the most common diseases of modern civilisation. Multimodal pain management (MPM) represents a central approach to avoiding surgery. Only few medium-term results have been published in the literature so far. This study compared subjective and objective as well as anamnestic and clinical parameters of 60 patients who had undergone inpatient MPM because of lumbar radiculopathy before and 1 year ±2 weeks after treatment. The majority of patients were very satisfied (35%) or satisfied (52%) with the treatment outcome. Merely 8 patients commented neutrally and none negatively. The finger-floor distance had decreased significantly (p < 0.01), and 30 patients (50%) had shown improved mobility of the spine after therapy. The need for painkillers had also been significantly reduced after 1 year. The arithmetical average of pain on a visual analogue scale was 7.21 before treatment, which had significantly decreased to 3.58 at follow-up (p < 0.01). MPM is an effective approach for treating lumbar radiculopathy by mechanical nerve root irritation. Therefore, in the absence of an absolute indication for surgery or an absolute contradiction for MPM, patients should first be treated with this minimally invasive therapy.

[Value of injection therapy for degenerative diseases of lumbar spine]

Local injection therapy is of great value in the border area between non-operative or operative treatment of discogenic and spinal stenotic radicular syndromes. With a series of deep periradicular infiltrations of local anesthetics and antiphlogistics it is possible to reduce the pain peaks in the spontaneous course of degenerative spinal diseases, so that planned surgery is no longer necessary. For the rare serious palsies immediate surgery is still necessary. On-going improvement is reached by physiotherapy and psychotherapy and with the back school.