EPIDURAL INJECTIONS IN THE TREATMENT OF RADICULAR SYNDROME AND CHRONIC LOWER BACK PAIN IN DEGENERATIVE-DYSTROPHIC SPINE DAMAGE.

Purpose of the study - to investigate the methodology and effectiveness of epidural steroid injection for radicular syndrome and lower back pain caused by degenerative-dystrophic spine damage. Research methods: bibliosemantic, comparative, systemic approach. The analysis of early and long-term results of treatment of patients with degenerative-dystrophic spine damage using epidural steroid injections by various authors and the author's own experience was carried out. Literature review and our study proved a high efficacy of both monotherapy and combined epidural steroid injections in the treatment of chronic lower back pain and radicular syndrome caused by degenerative-dystrophic spine damage. Epidural steroid injections are indicated for intervertebral disc herniation, spondyloarthritis, spinal canal stenosis, spondylolisthesis, which cause chronic lower back pain, radicular syndrome. Epidural steroid blockades with stable remission were proved to have positive result in 20 to 100% of cases, averaging more than 80%. Anesthetics, corticosteroids, enzymes, and vitamins are administered into the epidural cavity to relieve pain and inflammation, but most authors still prefer steroids. Corticosteroids reduce the inflammatory response and oedema by inhibiting the synthesis and release of numerous anti-inflammatory mediators and cause the reverse local anesthetic effect. Different approaches are used to administer drugs into the epidural cavity: interlaminar, caudal and transforaminal; the method of long-term local pharmacotherapy is used. Interlaminar epidural steroid injection is as effective as transforaminal epidural injection. The middle interlaminar access is less traumatic. The choice of the administration technique depends on experience and preferences of the specialist. Epidural injections are performed both by a "blind method" (without imaging) and under control (fluoroscopy, ultrasound, and CT) in order to improve the safety and carefulness of pharmacological drug administration. The equivalence of fluoroscopic, ultrasound and CT control of epidural injection in terms of treatment efficacy has been proved. Taking into account the high efficacy of epidural steroid injections, the possibility of outpatient treatment in the absence of complications, makes it the method of choice in the treatment of radicular and lower back pain caused by degenerative damage of the lower back spine, after ineffective treatment.