The Effect of Body Mass Index on the Outcome of Lumbar Epidural Steroid Injections: Six-Month Follow-Up
-
Masoud Hashemi
,
Gholam-Reza Mohseni
,
Shahin Salehi
,
Ali Reza Koosha
,
Mohamad Qoreishi
,
Payam Vedadian
,
Mahdi Hoseini Khameneh
Abstract
Obesity is a risk factor for severe, radicular, and debilitating lumbosacral pain. The use of non-surgical treatment methods in obese patients is important. Epidural steroid injection (ESI) is a common procedure that helps patients with low back pain and radicular symptoms. So far, using ESI in patients with lumbar herniated discs remains to be controversial among physicians. Thus, the current study was carried out to compare the therapeutic effects of ESI's in obese and non-obese patients with spinal disc herniation. This prospective, clinical trial study was conducted among 124 patients (58=non-obese, 66=obese) with low back pain caused by a lumbar herniated disc, who referred to our Pain Clinic from 2017 to 2018. The ESI was done using the parasagittal inter-laminar approach. The severity of pain was measured by the patients’ self-report of pain and using the visual analog scale (VAS) before the treatment and two and six weeks after the treatment. The Oswestry Disability Index (ODI) was also measured in the treatment groups. Patients were followed for 6 weeks (IRCT20131124015515N3). Overall, 58 (46.8%) patients had a BMI of 20-25 kg/m2, 38 (30.6%) had a BMI of 25-30 kg/m2, and 28 (22.6%) patients had a BMI of >30 kg/m2. The changes in the pain scores and ODI at different time periods showed no statistically significant differences in the two groups (P=0.685, P=0.995), respectively. The ESI is an effective, safe, minimally invasive, and cost-effective method that can result in pain relief and improvements in patients' function after a short period of time. Hence, we suggested that this treatment be considered for all patients with acute/chronic low back pain as well as radiculopathy.
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4. Samartzis D, Karppinen J, Cheung JP, Lotz J. Disk degeneration and low back pain: are they fat-related conditions? Global Spine J, 2013; 3(3):133-144.
5. Garzillo Mand Garzillo T. Does obesity cause low back pain? J Manipulative Physiol Ther 1994; 17(9): 601-4.
6. Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine 2000; 25(2): 226-37.
7. Leboeuf-Yde C, Kyvik K, Bruun N. Low back pain and lifestyle. Part II – Obesity. Information from a populationbased sample of 29,424 twin subjects. Spine 1999; 24(8):779-83.
8. K¨a¨ari¨a S, Leino-Arjas P, Rahkonen O, Lahti J, Lahelma E, Laaksonen M. Risk factors of sciatic pain: a prospective study among middle-aged employees. Eur J Pain 2010; doi:10.1016/j.ejpain.2010.11.008.
9. Heli¨ovaara M. Body height, obesity, and risk of herniated lumbar intervertebral disc. Spine 1987; 12(5): 469-72.
10. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari- Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010; 171(2): 135-54.
11. Urquhart D, Berry P,Wluka A, Strauss B, Wang Y, Proietto J, Jones G,Dixon J, Cicuttini F. Increased FatMass is Associated with High Levels of Low Back Pain Intensity and Disability. Spine 2011; doi: 10.1097/BRS.0b013e3181f9fb66
12. Patel N, Bagan B, Vadera S, Maltenfort M, Deutsch H, Vaccaro A, Harrop J, Sharan, A, Ratliff J. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 2007; 6(4): 291-7.
13. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.
14. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–2196.
15. Benditz A, Madl M, Loher M, Grifka J, Boluki D, Linhardt O. Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy. Sci Rep. 2016;6:28187.
16. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21–24.
17. Arnold B, Brinkschmidt T, Casser HR, et al. Multimodale Schmerztherapie Konzepte und Indikation [Multimodal pain therapy: principles and indications]. Schmerz. 2009;23(2):112–120.
18. Anson P. Experts say epidural steroid injections overused. Available from: http://www.painnewsnetwork.org/stories/2015/8/19/experts-sayepidural- injections-overused. Accessed May 1, 2016.
19. Berkman ND, Lohr KN, Ansari M, et al. Grading the strength of a body of evidence when assessing health care interventions: an EPC update. J Clin Epidemiol. 2015;68(11):1312–1324.
20. Kreiner DS, Hwang SW, Easa JE, et al; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180–191.
21. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5(1):e23139.
22. Chou R, Hashimoto R, Friedly J, et al. Pain Management Injection Therapies for Low Back Pain. Rockville, MD: Agency for Healthcare Research and Quality (US); 2015.
23. Botwin KP, Gruber RD, Bouchlas CG, et al. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000;81:1045–50.
24. Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336:1634–40.
25. Falco FJ. Lumbar spine injection procedures in the management of low back pain. Occup Med 1998;13:121–49.
26. Fredman B, Zohar E, Ben Nun M, et al. The effect of repeated epidural sympathetic nerve block on “failed back surgery syndrome” associated chronic low back pain. J Clin Anesth 1999;11:46–51.
27. Morcet N, Guggenbuhl P, Rolland Y, et al. Cervical epidural injection technic under computed tomography guidance in the treatment of cervicobrachial neuralgia. J Radiol 1999;80:161–2.
28. Watters WC, Baisden J, Gilbert TJ, et al. Degenerative lumbar spinal stenosis: An evidence-based guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 2007;8(2):305–10.
29. Barre LC, Lutz GE, Southern D, Cooper G. Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: A retrospective evaluation of long-term efficacy. Pain Physician 2004;2(7):187– 93.
30. Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 1998;14(2):148–51.
31. Cuckler JM, Bernini PA, Wiesel SW, et al. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am 1985;67(2):63–6.
32. Atlas SJ, Delitto A. Spinal stenosis: Surgical vs. nonsurgical treatment. Clin Orthop 2006;443:198–207.
33. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative spondylolisthesis. Eur Spine J 2007;17(3):327–35.
34. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007;10:7–111.
35. Rosenberg SK, Grabinsky A, Kooser C, Boswell MV. Effectiveness of transforaminal epidural steroid injections in low back pain: A one-year experience. Pain Physician 2002;5(3):266–70.
36. Ciocon JO, Galindo-Ciocon D, Amaranath L, Galindo D. Caudal epidural blocks for elderly patients with lumbar canal stenosis. J Am Geriatr Soc 1994; 42(6):593–6.
37. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transforaminal epidural steroid injection in degenerative lumbar stenosis: An outcome study. Am J Phys Med Rehabil 2002; 81(12):898–905.
38. Botwin KP, Sakalkale DP. Epidural steroid injections in the treatment of symptomatic lumbar spinal stenosis associated with epidural lipomatosis. Am J Phys Med Rehabil 2004;83(12):926–30.
39. Bahk JH, Kim JH, Lee JS, Lee SC. Computed tomographic study of lumbar (L3–4) epidural depth and its relationship to physical measurements in young adult men. Reg Anesth Pain Med 1998;23:262–265.
40. Chen KP, Poon YY, Wong CH. The depth to the epidural space. Ma Zui Xue Za Zhi 1989;27:353–356.
41. Clinkscales CP, Greenfield ML, Vanarase M, Polley LS. An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth 2007;16:323–327.
42. Segal S, Beach M, Eappen S. A multivariate model to predict the distance from the skin to the epidural space in an obstetric population. Reg Anesth 1996;21:451–455.
43. Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intensive Care 1993;21:309–310.
44. D’Alonzo RC, White WD, Schultz JR, Jaklitsch PM, Habib AS. Ethnicity and the distance to the epidural space in parturients. Reg Anesth Pain Med 2008;33:24–29.
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| Files | ||
| Issue | Vol 58, No 7 (2020) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v58i7.4420 | |
| Keywords | ||
| Epidural steroid injections Lumbar disc herniation Body mass index Outcome | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hashemi M, Mohseni G-R, Salehi S, Koosha AR, Qoreishi M, Vedadian P, Hoseini Khameneh M. The Effect of Body Mass Index on the Outcome of Lumbar Epidural Steroid Injections: Six-Month Follow-Up. Acta Med Iran. 2020;58(7):322-331.
