Quantitative sensory testing to evaluate and compare the results after epidural injection and simple discectomy, in pati
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ORIGINAL RESEARCH
Quantitative sensory testing to evaluate and compare the results after epidural injection and simple discectomy, in patients with radiculopathy secondary to lumbar disc herniation Irene Garcia‑Saiz1 · Enrique M. San Norberto2 · Eduardo Tamayo3 · Enrique Ortega1 · Cesar Aldecoa1,4 Received: 12 June 2019 / Accepted: 24 September 2019 © Springer Nature B.V. 2019
Abstract The objective assessment of the radiculopathy secondary to lumbar disc herniation is essential to optimize treatment. The quantitative sensory test (QST) is a useful tool to evaluate somatosensory nerves. The aim of our study is quantifying by QST the alterations of patients treated by epidural injections (EI) or surgical lumbar decompression (LD). A prospective, cohort study has done in Hospital Universitario Rio Hortega, Valladolid, Spain, between January 2014 and December 2016. The study includes 74 patients (40 men) who underwent EI (50) or LD (24) with lumbar disc herniation and treated by EI or LD. Participants underwent a brief battery of QST at baseline and after 1, 3 and 6 months of follow-up. QST threshold were measured in three series of five warm and cold stimuli (cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold) bilateral. Additionally, pain assessment (Visual Analogue Scale) and neurological examination was performed. Thermal thresholds were analysed and compared. In the EI group, warm detection threshold (WDT) measurements were significantly lower after 3 and 6 months of follow-up (40.44 ± 3.42°C vs. 38.30 ± 3.73°C and 37.48 ± 4.58°C respectively, p = 0.031 and p = 0.043). LD group showed lower WDT measurements at 1, 3 and 6 months of follow up (40.20 ± 2.97°C vs., 37.98 ± 2.04°C, 37.43 ± 3.80°C and 36.55 ± 2.77°C respectively, p = 0.049, p = 0.032 and p = 0.024) and lower heat pain threshold (HPT) levels after 3 and 6 months of follow-up (48.75 ± 1.37°C vs. 43.26 ± 0.60°C and 42.06 ± 1.37°C respectively, p = 0.037 and p = 0.021). QST explorations were compared between both groups. At 1-month follow-up only the WDT parameter was different, higher in EI group (40.98 ± 4.04°C vs. 37.98 ± 2.04°C, p = 0.043). There were no differences in any parameter measured by QST after 3 and 6-months follow-up between both groups. Epidural injection should be considered the first-step of treatment. Keywords Somatosensory disorders · Nociception · Radiculopathy · Epidural injection · Discectomy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-019-00395-9) contains supplementary material, which is available to authorized users. * Cesar Aldecoa [email protected] 1
Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012 Valladolid, Spain
2
Division of Vascular Surgery, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47003 Valladolid, Spain
3
Department of Anesthesia and Critical Care, Hospital Clínico Universitario de Valladolid, Avenid
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