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Evaluation of Sagittal Spinopelvic Alignment on Analgesic Efficacy of Lumbar Epidural Steroid Injection in Geriatric Patients

 Hee Jung Kim  ;  Min Gi Ban  ;  Miribi Rho  ;  Woohyuk Jeon  ;  Shin Hyung Kim 
 MEDICINA-LITHUANIA, Vol.58(10) : 1383, 2022-10 
Journal Title
Issue Date
Aged ; Analgesics, Opioid ; Female ; Humans ; Lordosis* / surgery ; Lumbar Vertebrae* / surgery ; Pain ; Retrospective Studies ; Steroids / therapeutic use
epidural steroid injection ; geriatric patients ; muscle degeneration ; pain management ; paraspinal muscles ; spinopelvic alignment
Background and Objectives: The aim of this study was to evaluate the impact of sagittal imbalance based on pelvic incidence-lumbar lordosis (PI-LL) mismatch on the analgesic efficacy of epidural steroid injection in geriatric patients. Materials and Methods: Patients aged 65 years or older who received lumbar epidural steroid injections under fluoroscopy were enrolled. The cutoff of PI-LL mismatch >20° was used as an indicator of a marked sagittal imbalance. The cross-sectional area of the psoas and paraspinal muscles, as well as the paraspinal fat infiltration grade were measured. A 50% or more decrease in pain score at four weeks after injection was considered as good analgesia. Variables were compared between PI-LL ≤ 20° and >20° groups and multivariate analysis was used to identify factors related to pain relief after injection. Results: A total of 237 patients consisting of 150 and 87 patients in the PI-LL ≤ 20° and >20° groups, respectively, were finally analyzed. Female patients, patients with lumbar surgery history, and the smaller cross-sectional area of the psoas muscles were predominantly observed in patients with sagittal imbalance. There was no difference in analgesic outcome after injection according to the PI-LL mismatch (good analgesia 60.0 vs. 60.9%, p = 0.889). Multivariate analysis showed that pre-injection opioid use, moderate to severe foraminal stenosis, and high-graded paraspinal fat infiltration were significantly associated with poor analgesia after injection. Conclusions: There was no significant correlation between sagittal spinopelvic alignment and pain relief after lumbar epidural steroid injection for geriatric patients.
Files in This Item:
T202204641.pdf Download
10.3390/ medicina58101383
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Kim, Hee-Jung(김희정) ORCID logo https://orcid.org/0000-0002-2143-3943
Rho, Miribi(노미리비) ORCID logo https://orcid.org/0000-0002-1703-7657
Ban, Min Gi(반민지) ORCID logo https://orcid.org/0000-0002-1116-9472
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