Lee K.-C.1,2, Chen L.-C.1,2, Chang S.-T.2,3
1Tri-Service General Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 2School of Medicine, National Defense Medical Center,, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 3Taichung Veterans General Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan
Background: Lumbar Herniated Intervertebral Disk (HIVD) has a high clinical prevalence, and patients consume a substantial amount of healthcare resources in Taiwan. Most patients prefer conservative physical therapy to decompression surgery which has higher risk and longer immobilization period. Another invasive treatment “epidural steroid injection” can get immediate pain relief, but it has not been used broadly in Taiwan.
Purpose: Many patients with lumbar HIVD problems are young adults and they are usually the working resource in our society. Conservative PT programs can relieve symptoms but take lots of time and money. So I want to study whether combining epidural steroid injection can get faster effects and spend a reasonable cost than the conservative PT programs only.
Methods: Patients with main diagnosis of lumbar HIVD with root compression were separated to two groups. The experimental group received epidural cadual injection (80 mg Solu-Medrol + 0.15% Lidocaine) and conservative PT programs. The control group received PT programs only. Conservative PT programs included diathermy, lumbar traction, and exercise therapy. Two groups both received in-hospital treatments. We collected the data of pre-treatment, one week and one month after the treatments. The treatment effect indicators included Oswestry Disability Index (ODI), depressive scores, decrease of back pain and leg pain. Then we also compared the intervention cost which included physical therapy charge, drug expenses and injection fee for cost-effectiveness analysis. We chose ICER (incremental cost-effectiveness ratio) method to calculate the cost-effectiveness analysis (CEA).
Results: The experimental group consisted of 24 patients, with a mean age of 24.29 ± 2.40 years. The control group included 37 patients, with a mean age of 23.49 ± 1.79 years. All the patients were male military personnel. No significant difference (P > 0.05) was found in the basic information of the two groups. The experimental group and control group both had obvious improvement after the treatment one week and one month. These results indicated that both treatments are effective. Then we compare the differences between the two groups. The experimental group got better improvements than the control group, especially in the decrease of back pain (p=0.005) and ODI (p=0.049). Using the ICER (ΔC/ΔE) method, the experimental group had better ICER (1763.4 NTD/degree) than the control group (2402.2 NTD/degree) despite higher intervention cost (5180 NTD in experimental group and 3132 NTD in control group).
Conclusion(s): Conservative PT programs combining epidural steroid injection have better short-term effects than PT programs only in relieving back pain and improving daily activities. Although the epidural steroid injection had higher intervention cost, but it showed better cost effectiveness analysis.
Implications: Lumbar herniated intervertebral disk is troublesome problems in clinic. Epidural steroid injection combines conservative PT programs is another good intervention for short-term effect and cost effectiveness.
Funding acknowledgements: We thank the Tri-Service General Hospital Public Consultation Fund (Project No. TSGH-C104-191).
Topic: Musculoskeletal: spine
Ethics approval: This study was approved by the Human Trial Committee of the Tri-Service General Hospital (TSGHIRB: 094-050028).
All authors, affiliations and abstracts have been published as submitted.
