- CConnexion
RééDOC
75 Boulevard Lobau 54042 NANCY cedex Christelle Grandidier Documentaliste 03 83 52 67 64 0
|
Therapeutic spinal corticosteroid injections for the management of radiculopathies
SLIPMAN CW; CHOW DW
PHYS MED REHABIL CLIN N AM , 2002, vol. 13, n° 3, p. 697-711 Doc n°: 106060 Localisation : Documentation IRR Descripteurs : AC232 - ATTEINTES DES NERFS RACHIDIENS Current literature and a recent meta-analysis suggest a favorable role for corticosteroid injections in the nonoperative treatment of radiculopathy [70]. The superior results reported in recent literature may be attributable to precise fluoroscopically guided transforaminal placement of injectate close to the disc-nerve root interface and near the dorsal root ganglia, maximizing the therapeutic effect. The favorable results of corticosteroid injections in the treatment of radiculopathy caused by a focal disc herniation are consistent with the biochemical construct of radicular pain. The preliminary unfavorable results of therapeutic SNRB for radicular pain caused by epidural or intraneural fibrosis or occurring after trauma may relate to a biomechanical rather than a biochemical etiology. Outcomes for acquired cervical or lumbar spinal stenosis are intermediate compared with those observed for herniated discs and scarring or trauma. Such results may stem from the multifactorial origin of stenosis symptoms; they may develop from impaired venous flow, restricted neural glide, inflammation, or structural root injury. Better-designed studies that use strict inclusion criteria that stratify patients into categories according to the mechanism of injury (atraumatic versus traumatic), the presence or absence of neurologic deficits or imaging abnormalities, and prior treatment will provide the basis for evidence-based treatment decisions. Such an emphasis is just beginning and inevitably will occur. Until then, decisions have to be predicated on the limited and flawed work conducted to date [71]. Nevertheless, the information gleaned from these published reports provides valuable insight not available just a decade ago. Langue : ANGLAIS Identifiant basis : 2002224132 |
0
|