الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 187 |  |  |
| | | from | 187 | | |
Abstract
This study was carried to evaluate the efficacy of perineural injection of dextrose 5 % buffered with sodium bicarbonate subcutaneously in treating patients with chronic low back pain caused by degenerative lumbosacral disc diseases.
It was a prospective randomized study that performed on forty patients with chronic low back pain; they were diagnosed clinically and radiologically.
The exclusion criteria included diabetic patients or patients with metabolic syndrome, patients with history of previous back interventional procedures including surgery, injection or epidural anesthesia, obvious ongoing psychiatric illness to ensure objective feedback from the patient after each session, patient with skin pathology at site of injection such as infection or wound, patient with skin malignancy like malignant melanoma to avoid exacerbation of malignancy, history of back trauma within 3 months prior to study, history of coagulation disturbances to avoid hemorrhagic disorders and avoid bruises after needling, complete rupture of spinal or pelvic ligaments or a tendon, patients with inflammatory back pain and fibromyalgia patients.
All patients were subjected to full history taking, full clinical examination including detailed back examination and neurological assessment of the lower limbs.
The patients were divided in two groups. In group 1, twenty patients received PNI sessions, the injection was done once weekly for 8 sessions with dextrose 5%(500ml) buffered with 2.4 ml sodium bicarbonate (8.4% concentration). In each session; 5-10 ml was injected subcutaneously with insulin syringe with angle of introduction 30-40 around lumbar and sacral nerves according to our map. In group 2, twenty patients received physical rehabilitation program (TENS, US, IR and massage if needed+ home exercise) 3 days per week 1 day apart for 4 weeks.
All Patients in the two groups were assessed pre-treatment and 8 weeks post treatment in group 1 and after 4 weeks in group 2. Assessment included clinical examination, provocative tests, functional scales.
Results: Our forty cases were 17 males and 23 females; and their mean age was 36.8 ± 4.7.
Our results showed:
• Significant improvement in ROM post treatment in the group 1 compared to group 2.
• A highly statistical significant difference in VAS and ODI scores post treatment in group 1 compared to the group 2.
• PNI was significantly associated with higher improvements measured by VAS, ROM and ODI when compared with group 2.
• Significant positive correlation between age and disease duration in the 1st group.
• Significant positive correlations between ROM & VAS.
• ODI change showed significant positive correlation with age and VAS change in group 1.
• In the 1st group; VAS change showed significant positive correlations with each of flexion tips to floor change and lateral flexion.
• In the 2nd group; VAS change showed positive correlations with flexion change, flexion tips to floor change and lateral flexion.
Studies recommend PNI as alternative, conservative and therapeutic modality either alone or addition to physiotherapy as it has low cost to chronic degenerative lumbosacral lesions as conservative treatment.