Effects of Integrative Korean Medical Treatment for a Failed Epidural Steroid Injections to L-spine Disk Herniation: A Retrospective Case Series

Article information

Acupunct. 2015;32(4):2287-7797
1Dept. of Acupuncture & Moxibustion, Mokhuri Neck&Back Oriental Medicine
2Dept. of Rehabilitation, Mokhuri Neck&Back Oriental Medicine
3Dept. of Oriental Medicine Philosophy, Graduate School, Kyung Hee University
4Dept. of Spine Center, Mokhuri Neck&Back Oriental Medicine
5Korean Medicine Clinical Trial Center, Kyung Hee University Korean Medicine Hosptial
*Corresponding author: Korean Medicine Clinical Trial Center, Kyung Hee University Korean Medicine Hosptial, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea, Tel: +82-2-958-9194, E-mail: rockandmineral@gmail.com
Received 2015 November 13; Revised 2015 December 11; Accepted 2015 December 14.

Abstract

Objectives:

The purpose of this study was to assess the effectiveness of integrative Korean Medical treatments for patients with L-spine disk herniation that showed no response to Epidural Steroid Injections (ESI)

Methods:

In this study, we reviewed the medical records of ten patients who showed no improvement or relapsed after ESI. The patients each received more than three weeks of integrative treatments at Mokhuri Neck&Back Hospital. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) was measured before and after treatment A statistical analysis to compare before and after treatments was assessed using paired t-test the SPSS 12.0 Windows program

Results:

After three weeks of treatment, patients showed a significant decrease in VAS and ODI scores compared to before receiving treatment. VAS scores decreased from 5.3±1.25 to 1.9±0.99 (p<0.001) and ODI scores decreased from 59.8±22.2 to 32.7±14.11 (p<0 001).

Conclusions:

Complex Korean Medical treatment showed effectiveness in the treatment of L-spine HIVD patients that showed no response to ESI, and more objective research is needed.

Fig. 1

Changes of VAS (Visual Analog Scale)

*: There is significant stastically significance between average VAS score of PAD 1 and PAD 22. (P<0.001)

Fig. 2

Changes of ODI (Oswestry Disability Index)

*: There is significant stastically significance between average ODI score of PAD 1 and PAD 22. (P<0.001)

Composition of Gangchuctang Used in This Study

Characteristics of Subjects

Changes of VAS and ODI average score before and after Korean Medical Conbination Treatments

References

1. Ahn JH, Ahn JC, Ahn JK, et al. Orthopaedics 7th edth ed. Seoul: Choisin Medical Publishing Co; 2013. p. 865–8.
2. Cherkin DC, Deyo RA, Loeser JD, et al. An international comparison of back surgery rates. Spine 1994;19(11):1201–6.
3. Kreiner DS, Hwang SW, Easa JE, et al. An evidence–based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. The Spine Journal 2014;14(1):180–91.
4. Leung SM, Chau WW, Law SW, Fung KY. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J 2015;21(05):394–400.
5. Epstein NE. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review. Surg Neurol Int 2015;6(Suppl 14):S383–7.
6. Zhai J, Zhang L, Li M, et al. Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta–analysis of ten randomized controlled trials. Int J Clin Exp Med 2015;8(6):8304–16.
7. Kim HS, Kim SY, Kim HJ, Kim ES, Kim YI. The Effect of Acupotomy on Lumbar Herniated Intervertebral Disc: Report of a Case Series. The Acupuncture 2015;32(3):185–95.
8. Park OJ, Kim SG, Lee JJ, Lee SM, Kim SJ, Cho NG. The Effect of Shinbaro and Bee Venom Pharmacopuncture in Treating Lumbar Disc Herniations. The Acupuncture 2013;30(5):41–50.
9. Kim SM, Lee SH, Shin YB, et al. The Effect of Korean Medical Combination Treatment on 72 Cases of Herniated Intervertebral Lumbar Disc Patients: An Observational Study. The Acupuncture 2015;32(2):23–33.
10. Davidson M, Keating J. Oswestry disability questionnaire(ODQ). Australian Journal of Physiotherapy 2005;51(4):270.
11. Seidler A, Euler U, Bolm–Audorff U. Physical workload and accelerated occurrence of lumbar spine diseases: risk and rate advancement periods in a German multicenter case-control study. Scand J Work Environ Health 2011;37(1):30–6.
12. Sari S, Aydin ON, Güleser G, Kurti , Turan A. Effect of transforaminal anterior epidural steroid injection on neuropathic pain, quality of sleep and life. Ağr i 2015;27(2):83–8.
13. Çetin MF, Karaman H, Ölmez Kavak G, Tüfek A, Baysal Yildirim Z. Efficacy of transforaminal lumbar epidural steroid injections in patients with lumbar radiculopathy. Ağri 2012;24(2):77–84.
14. Manchikanti L, Cash KA, Pampati V, Falco FJ. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double–blind, active–control trial. Pain Physician 2014;17(4):489–501.
15. Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician 2009;12(1):163–88.
16. El Abd O, Amadera J, Pimentel DC, Gomba L. Immediate and acute adverse effects following transforaminal epidural steroid injections with dexamethasone. Pain Physician 2015;18(3):277–86.
17. Lee EK, Choi EH, Lee JE, et al. The clinical study on 137 cases of herniated lumbar disc patients. The Acupuncture 2008;25(3):127–38.
18. Kim WY, Han SY, Kim KY, Lee JH, Lee HJ, Kim CY. A Clinical Study of 17 Cases of Patients with Big Toe Extensor Muscles Weakness Caused by Lumbar Disc Herniation. The Acupuncture 2009;26(4):19–27.
19. Park SH, Ro HR, Kim TH, Park JY. The Comparative Study on the Effect of Bee Venom Pharmacopuncture Treatment and Hwangryun Pharmacopuncture Treatment of Cervical Disc Herniation. The Acupuncture 2013;30(3):117–24.
20. Ju MS, Jeong HU, Kim HG, et al. Anti–nociceptive and anti–inflammatory effects of Geranii Herba. Kor J Herbology 2010;25(3):97–101.

Article information Continued

Fig. 1

Changes of VAS (Visual Analog Scale)

*: There is significant stastically significance between average VAS score of PAD 1 and PAD 22. (P<0.001)

Fig. 2

Changes of ODI (Oswestry Disability Index)

*: There is significant stastically significance between average ODI score of PAD 1 and PAD 22. (P<0.001)

Table 1

Composition of Gangchuctang Used in This Study

Scientific name Amounts (g)
Geranii herba 8
Sorbus commixta 8
Archyranthes radix 4
Cibotii rhizoma 4
Acanthopanax sessiliflorum seeman 4
Ledebouriella seseloides 4
Eucommia ulmoides Oliver 4
Atractylodes macrocephala Koidzumi 4
Aralia continentalis Kitagawa 4
Rehmannia glutinosa for hueichingensis 4
Carthamus tinctorius 1.5
Total 49.5

Table 2

Characteristics of Subjects

age sex Diagnosis Hospitalization Period(days) the number of injection
patient 1 37 M HIVD* of L4/5 23 4
patient 2 34 F HIVD of L5/S1 25 3
patient 3 33 M HIVD of L4/5 22 1
patient 4 24 M HIVD of L4/5 31 2
patient 5 49 M HIVD of L4/5 22 2
patient 6 54 F HIVD of L5/S1 34 2
patient 7 20 M HIVD of L4/5 23 3
patient 8 60 F HIVD of L4/5 24 1
patient 9 53 F HIVD of L4/5 22 1
patient 10 32 F HIVD of L4/5, L5/S1 23 2
*

HIVD: Herniated InterVertebral Disk.

Table 3

Changes of VAS and ODI average score before and after Korean Medical Conbination Treatments

ODI VAS
PAD 1§ PAD 22 PAD 1 PAD 8 PAD 15 PAD 22
patient 1 36 18 4 3 3 1
patient 2 82 54 5 4 3 2
patient 3 92 44 6 4 3 2
patient 4 26 18 5 3 2 1
patient 5 40 18 6 5 4 3
patient 6 74 44 8 6 5 4
patient 7 50 20 4 3 2 1
patient 8 50 25 4 2 2 1
patient 9 76 42 6 5 4 2
patient 10 72 44 5 4 3 2
mean 59.8±22.2 32.7±14.11 5.3±1.25 3.9±1.20 3.1±0.99 1.9±0.99
p-value* 0.000018 0.00000000637
*

: p-value by paired t-test in before and after treatment (p<0 05)

ODI: Oswestry Disability Index,

VAS: Visual Analog Scale.

§

PAD: Post Administration Date.