Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of the Effectiveness of Prolotherapy and Facet Joint Injection in the Treatment of Chronic Low Back Pain: A Retrospective Study
Kronik Bel Ağrısının Tedavisinde Proloterapi ile Faset Eklem Enjeksiyonunun Etkinliğinin Karşılaştırılması: Retrospektif Çalışma
Timur YILDIRIMa
aDepartment of Neurosurgery, Karatay University Faculty of Medicine, Konya, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(1):1-6
doi: 10.5336/medsci.2020-80271
Article Language: EN
Full Text
ABSTRACT
 Objective: Low back pain is a common public health problem and causes serious socioeconomic losses. The most common etiology is mechanical in origin. Noninvasive treatment methods, such as medication, exercise, and physical therapy, should be applied first. The most commonly used methods among percutaneous interventions are prolotherapy, facet joint corticosteroid injection, and medial branch blocks. In our study, the effectiveness of facet joint injection and prolotherapy procedures was evaluated in patients with chronic low back pain using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Material and Methods: Data from 178 patients who underwent facet joint injection and prolotherapy with a diagnosis of chronic low back pain in our clinic between 2013 and 2019 were evaluated. In the study, 20 mg of methylprednisolone combined with 2-4 mL of 0.25% bupivacaine was used for facet joint injection. 5 mL of 25% dextrose solution was used for prolotherapy injection to the faset capsule. The VAS and ODI results were evaluated and analyzed before and after the procedures. Results: Preintervention VAS scores were higher in patients who received facet joint injections than in those who received prolotherapy (p<0.001). Facet treatment significantly decreased VAS scores on the first day (p<0.001). Prolotherapy became a more effective treatment later, as reflected by VAS scores at 3 months (p<0.001). The 3-month ODI scores were higher in patients treated with prolotherapy (p<0.001). Conclusion: Facet joint injection is considered more effective at relieving symptoms of back pain early in the condition, but prolotherapy provided more benefit, according to long-term VAS scores.

Keywords: Facet joint injection; prolotherapy; low back pain
ÖZET
 Amaç: Bel ağrısı, toplumda yaygın görülen bir sağlık sorunudur ve ciddi sosyoekonomik kayıplara neden olur. Etiyolojide en sık neden mekanik bel ağrısıdır. İlaç, egzersiz ve fizik tedavi gibi girişimsel olmayan yöntemler öncelikle uygulanmalıdır. Perkütan girişimler arasında en sık kullanılan yöntemler; proloterapi, faset eklem kortikosteroid enjeksiyonu, mediyal dal bloklarıdır. Çalışmamızda, kronik bel ağrılı hastalarda yapılan faset eklem enjeksiyonu ve proloterapi işlemlerinin etkinliği ve farklılıklarını vizüel analog skala (VAS) ve Oswestry Yetersizlik İndeksi [Oswestry disability index (ODI)] kullanarak, geriye dönük olarak inceledik. Gereç ve Yöntemler: Kliniğimizde 2013 ve 2019 yılları arasında kronik bel ağrısı tanısı ile faset eklem enjeksiyonu veya proloterapi uygulanan 178 hastanın verileri değerlendirildi. Çalışmada, faset eklem enjeksiyonu için 2-4 mL %0,25 bupivakain ile karıştırılarak, 20 mg metilprednizolon kullanıldı. Proloterapi enjeksiyonu için faset eklem kapsülüne 5 mL %25 dekstroz solüsyonu kullanıldı. Hastaların VAS ve ODI skorları, işlem öncesi ve sonrası takip dönemlerinde değerlendirilerek analiz edildi. Bulgular: Faset eklem enjeksiyonu uygulanan olgularda işlem öncesi VAS değerleri proloterapi alanlara göre daha yüksekti (p<0,001). Faset tedavisi, 1. gün VAS skorlarını belirgin düşürdü (p<0,001). Üçüncü aydaki VAS skorlarına bakıldığında proloterapi daha etkili bir tedavi haline geldi (p<0,001). Proloterapi uygulanan hastalarda, 3. ay ODI skorları istatistiksel olarak yüksekti (p<0,001). Sonuç: Faset eklem enjeksiyonunun, enjeksiyon sonrası erken dönemde hastalığın semptomlarının giderilmesinde daha etkili olduğu düşünülürken, 3. ay takipleri incelendiğinde proloterapinin uzun dönem VAS sonuçları üzerinde istatistiksel olarak daha anlamlı fayda sağladığı görülmektedir.

Anahtar Kelimeler: Faset eklem enjeksiyonu; proloterapi; bel ağrısı
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