ABSTRACT
BACKGROUND: Inflammatory mediators-induced neurodocitis in the nucleus pulposus is a main factor for backleg pain. Receptor pathway studies confirmed that the nervous system had self-circulation. Administration by receptors has the same effect as targeting drug delivery. OBJECTIVE: To evaluate the therapeutic efficacy of drug injection on synovium of lumbar zygapophyseal joints and muscular attachment point of neural scute in 1 236 patients with discogenic low back pain. DESIGN,TIME AND SETTING: The case analysis experiment was performed at the First People’s Hospital from March 2002 to March 2007. PARTICIPANTS: 1 236 patients with discogenic low back pain were selected at the Department of Pain,including 370 males and 866 females,aged from 20 to 80 years. The patients accompanied with bulging of lumbar intervertebral disc and protrusions less than 1/3 vertebral canal. METHODS: Drugs were injected on bulges of lumbar intervertebral disc,protuberate zygapophysis and neural scute. General pharmaceutical formulation: Betamethason copound injection 5 mg+ levofloxacin 0.1 g+20 g/L lidocaine 5 mL+sacine metered to 20 mL+ sodium hyaluronate 20 mg. The administration was once a week and one course of treatment had three administrations. There was no overweight loading during one month. MAIN OUTCOME MEASURES: Therapeutic efficacy; relapse rate. RESULTS: In 1 236 patients with one course of treatment,there were healing in 1 142 cases (94%),improvement in 89 cases (7.2%),inefficacy in 5 cases (0.4%). In 322 patients with one year consummate data,there were no relapse in 250 cases (77.6%),relapse in 72 cases (22.4%). In 206 patients with two year consummate data,there were no relapse in 155 cases (75.2%),relapse in 51 cases (24.8%). In 91 patients with three year consummate data,there were no relapse in 74 cases (81.3%),relapse in 17 cases (18.7%). In 62 patients with four year consummate data,there were no relapse in 52 cases (83.8%),relapse in 10 cases (16.2%). In 32 patients with five year consummate data,there were no relapse in 27 cases (84.3%) and relapse in 5 cases (15.6%). CONCLUSION: Drug injection on synovium of lumbar zygapophyseal joints and muscular attachment point of neural scute through receptor-mediated pathway is simple and available in patients with discogenic low back pain.