腰椎椎間板ヘルニアに対する椎間板内加圧注射法の有効性

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  • Clinical Investigation for the Effect of Intradiscal Pressurized Injection Therapy for Lumbar Disc Herniation

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The treatment for the patients with lumbar disc herniation is generally conservative, but not a few patients require surgery. The intradiscal pressurized injection therapy conceived in 1992 by Yoshida is a method to avoid surgery.<br> The authors analysed cases of patiants younger than 40 years with lumbar disc herniation, who could not control their pain and had requested surgical treatment such as the intradiscal pressurized injection therapy. We injected a combination of 10 cc of saline, 2 cc of 2% Xylocaine and 2 cc of Decadron through the dura mater by the central approach with Isovist.<br> We reviewed 14 cases (10 men and 4 women, mean age 26.6 years). The average period from primary pain to the intradiscal pressurized injection therapy was 20 weeks (range 4-64 weeks). The mean Japan Orthopaedic Association (JOA) score for low back pain for the 14 cases was 11.4 points (range 2-20 points). The authors classified the effect at one week after the pressurized injection into excellent, good, fair and poor groups.<br> The excellent group had 7 patients, good group had 4 patients, fair group had 3 patients and the poor group had none. There were 2 patients in each group who required surgery. Three of four patients with the protrusion type on MRI underwent operation. Three patients in ten patients with the extrusion hernia required surgery. Two of 8 patients with central type herniation required surgery. Four of 6 patients with posterolateral herniation underwent operation. All who had high intensity in MRI T2 improved and could avoid surgery.<br> We expected the center approach would make the intradiscal pressurized injection therapy more effective for patients with central type herniation. One week after the intradiscal pressurized injection therapy, the patients were comfortable, but eventually half of the patients needed surgery.<br> We concluded that the intradiscal pressurized injection therapy was useful for some patients younger than 40 years with lumbar disc herniation on the condition that we gave thorough informed consent.

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