Steroids Spinal Injections

[Lumbar transforaminal epidural block for treatment of low back pain with radicular pain]

OBJECTIVE

To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.

METHODS

We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.

RESULTS

The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P < 0.001), and such improvements became more obvious over time after LTEB (P < 0.01).

CONCLUSIONS

As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

Analytical method development and validation of hydrocortisone and clotrimazole in topical dosage form using RP-HPLC

Background

Different pharmaceutical topical agents are available in the market for the treatment of fungal infections. A simple, precise, and cost-effective RP-HPLC method was developed and validated for the determination of hydrocortisone and clotrimazole simultaneously in a topical cream dosage form. Chromatographic separation was done on USP L1 (250 × 4.6) mm column with a particle size of 5 μm. The mobile phase employed for this study consists of acetonitrile and buffer in the ratio of 75:25, respectively. The flow rate was kept at 1 mL per minute. The detection of the drug was carried out at 254 nm using a UV detector. The retention times of HYD and CL were 3.0 min and 7.3 min, respectively.

Result

The method is developed and validated for linearity, precision, specificity, accuracy, and robustness.

Conclusion

The stability of finished products gives us knowledge about the effect of different environmental factors like humidity, light, and temperature, and these factors give us information about the quality of finished products.

Confluent abscesses in autochthonous back muscles after spinal injections : A case report and narrative review of the literature on low back pain and spinal injections

Injection therapy is a frequently used method for the treatment of subacute and chronic low back pain (LBP) despite scant evidence for its effectiveness. To date there are relatively few studies comparing this method with other treatments. Moreover, there are many possible side effects associated with injection therapies, some of which are potentially life threatening. We present the case of a 59-year-old woman admitted to the emergency department with confluent abscess formations of autochthonous back muscles and staphylococcal sepsis caused by injection therapy performed by a general practitioner for LBP. The findings of this case report emphasize a careful selection of patients for this type of treatment and a multidisciplinary approach to treatment of LBP.

Image-Guided Percutaneous Treatment of Lumbar Stenosis and Disc Degeneration

Low back pain, radicular leg pain, and lumbar spinal stenosis are the most common of all chronic pain disorders. Discogenic pain is related to distress of annular fibers and tears, whereas spinal stenosis is related to reduction of the spinal canal dimensions and compression of the neural elements; radicular pain is mainly related to disc herniation and is initially managed conservatively. The percutaneous minimally invasive approach in discogenic and radicular pain is designed to reduce the volume of the nucleus pulposus in patients with failure of medical and physical treatment prolonged for at least 6 weeks.