TRANSFORAMINAL NERVE ROOT SLEEVE INJECTION WITH CORTICOSTEROIDS, HYALURONIDASE, AND LOCAL-ANESTHETIC IN THE FAILED BACK SURGERY SYNDROME

Millions of patients with chronic sciatica are still treated with epid ural corticosteroids. The efficacy of epidural corticosteroids remains questionable, especially in the chronic failed back surgery syndrome (CFBSS). The affected nerve root sleeve(s) are localized with the help of fluoroscopy and contrast dye. Local anesthetic diluted in 1,500 U hyaluronidase and 40 mg methylprednisolone is injected. Twenty patient s with CFBSS, a small retrospective pilot study group, were treated. T he success rate is evaluated using a verbal pain rating scale, 1 month and 3 months after the last injection. Initially, 12 patients obtaine d very good pain relief, sustained for >3 months in 11 patients. In on e patient, pain returned after >1 month. No complications were observe d. This technique is worthwhile for patients with CFBSS and where epid ural fibrosis is suspected to be the pain origin.