Perineural Therapy in Treatment of Chronic DegenerativeLumbosacral Lesions

AbstractBackground: Low Back Pain (LBP) is the most frequenttype of musculoskeletal pain. “It is often recurrent and oftenhas important socio-economic consequences.Aim of Study: The aim of this study is to evaluate efficacy of perineural injection in treatment of chronic low back pain due to degenerative lumbosacral lesions among sample of Egyptian population.Patients and Methods: A prospective randomized casecontrolled study was performed on forty patients with subacuteand chronic low back pain; they were diagnosed clinicallyand radiologically as having degenerative disc lesion. Thepatients were randomly divided in two groups. In group 1,twenty patients received PNI sessions, the injection was doneonce weekly for 8 sessions with dextrose 5% (500ml) bufferedwith 2.4ml sodium bicarbonate (8.4% concentration). In eachsession; 5-10ml was injected subcutaneously with insulinsyringe with angle of introduction 30-40 degrees which targets:Pain located in thoraco-dorsal fascia, the fascia of the erectorspinae muscles along T10 to L2 dorsal rami, interspinoustenderness from medial branches of dorsal rami, superiorcluneal nerve at 7-8 cm from middle line cross the iliac crest& T10 cross over iliac crest at a distance 8-10cm. In group2, twenty patients received physical rehabilitation programTranscutaneous Electrical Nerve Stimulation (TENS), Ultra-sound (US), infrared light (IR) and massage if needed+ homeexercise) 3 days per week 1 day apart for 4 weeks.Results: Our forty cases were 17 males and 23 females;their mean age was 36.8±4.7. Significant improvement inROM post-treatment in the group 1 compared to group 2. Ahighly statistically significant difference in VAS (VisualAnalogue Scale) and Oswestry Disability Index (ODI) scorespost-treatment in group 1 compared to the group 2. PNI wassignificantly associated with higher improvements measuredby VAS, ROM and ODI when compared with group 2. Signif-icant positive correlation between age and disease durationin the 1st group. Significant positive correlations betweenROM & VAS. ODI change showed significant positive corre-lation with age and VAS change in group 1. In the 1st group;VAS change showed significant positive correlations witheach of flexion tips to floor change and lateral flexion. In the 2nd group; VAS change showed positive correlations withflexion change, flexion tips to floor change and lateral flexion.Group 1 showed more positive correlations regarding ROMdue to improvement of pain score.Conclusion: PNI with Dextrose 5% achieved short termimprovement in pain and functional abilities in patients withlow back pain secondary to degenerative lumbosacral disclesions at least for a short-term. The degree of improvementof pain and functional abilities was higher in the group thatreceived PNI compared to the group that received physicalrehabilitation program.