الفهرس 
Anatomy of lumbosacral regionOnly 14 pages are availabe for public view
 |  | from | 230 |  |  |
| | | from | 230 | | |
Abstract
Low back pain is a very common cause of pain and disability. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 40% to 50% of chronic low back pain. The most common conservative treatment options for discogenic back pain include activity restriction, medications, physical therapy and chiropractic treatment. Many patients have an inadequate response to these conservative measures and progress to surgical treatment. The aim of our study was assessing and comparing the efficacy of caudal epidural steroid injection and pulsed electromagnetic field stimulation in treatment of patients with chronic low back pain. This study was carried out on 60 patients with chronic discogenic low back pain with or without radicular pain. Fifteen apparently healthy persons were taken as control group. The patients were divided randomly into two groups according to the line of treatment (group I treated with ultrasound guided caudal epidural corticosteroid injection and group II treated with pulsed electromagnetic field stimulation). Assessments: I. Clinical assessment by: a) Complete history taking and thorough clinical examination. b) Low back Pain assessment by Visual analogue scale (VAS). c) Degree of tenderness. d) Range of motion of back (Lumber flexion and Lateral flexion). e) Complete neurological examination. II. Functional assessment by: Oswestry disability index. III. Electrophysiological studies: a) Motor nerve conduction of peroneal and posterior tibial , Sensory nerve conduction study of the sural nerve, F wave of posterior tibial & peroneal nerve and H reflex. b) Electromyography of medial head of gastrocnemius, EDB and anterior tibial muscles. IV. Radiological assessment by: MRI of lumbosacral region. V. Laboratory assessment by: Serum level of beta-endorphin was measured. Clinical, functional and laboratory assessment was done before, after treatment and at 6 months later as follow up. Our results showed that there was no statistically significant differences between the two studied groups regarding age, sex, duration of the disease, degree of pain, degree of tenderness, range of motion of back , functional assessment and serum beta endorphin before treatment. As regard clinical assessment: There was significant improvement in low back pain (VAS) and degree of tenderness after treatment as compared to before treatment in both groups. Still further significant improvement in VAS was obtained at the end follow up when compared to before treatment in group I only. On comparing the improvement of the degree low back pain in the two studied groups we found the difference was insignificant at the end of treatment and at follow up period compared with before treatment, but there was statistically significant improvement of pain at the end of follow up when compared to after treatment in group I. On comparing grades of tenderness in the two studied groups we found after treatment and at the end of follow up the improvement in the degree of tenderness was significantly better in group I compared to group II. As regard back movement our study showed improvement in lumbar flexion and lateral lumbar flexion after treatment and at follow up as compared to before treatment in group I and II. On comparing the two studied groups regarding the improvement in back mobility, there was better improvement in group I as regard lumbar flexion after treatment and at the end of follow up. Whereas, the Improvement of lateral lumbar flexion showed insignificant difference between the two groups of patients at the end of treatment and at follow up period compared with before treatment but there was significant better improvement of lateral lumbar flexion at the end of follow up when compared to after treatment in group I. As regard to functional status our result showed significant improvement of functional status after treatment and at follow up period as compared to before treatment in both groups. On comparing the two studied groups regarding the Improvement of functional status measured by Oswestry disability index we found insignificant difference between the 2 groups of patients at the end of treatment compared with before treatment but there was significant better improvement of functional status at the end of follow up when compared to before treatment in group I. Regarding serum beta endorphin, there was improvement of serum level of beta endorphin after treatment and follow up period as compared to before treatment in both groups. On comparing the two groups regarding serum beta endorphin our result showed insignificant difference between two groups of patients at the end of treatment and at follow up period compared with before treatment and at the end of follow up when compared to after treatment.