So sánh hiệu quả phong bế rễ thần kinh cạnh sống dưới hướng dẫn siêu âm và tiêm ngoài màng cứng qua lỗ xương cùng trong điều trị đau thần kinh tọa do thoát vị đĩa đệm cột sống thắt lưng

Abstract

A prospective comparative study was conducted from June 2024 to June 2025 including 120 patients with sciatica secondary to lumbar disc herniation, comparing (1) ultrasound-guided selective paravertebral nerve root block and (2) caudal epidural steroid injection via the sacral hiatus; all patients received a single injection of dexamethasone 3.3 mg/1mL. Pain and disability were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI), and the composite response was evaluated at weeks 4 and 12. Treatment response was defined as a ≥ 50% reduction in VAS and a ≥ 10-point improvement in ODI. Baseline characteristics were comparable between groups with respect to age, gender, lesion level, and clinical pain severity. VAS decreased in both groups; at week 1, the ultrasound-guided group had a lower VAS score (p = 0.01), whereas no between-group difference was observed from week 4 to week 12. ODI improvement was greater in the ultrasound-guided group at week 4 (p = 0.01) and week 12 (p = 0.006). The composite response rate at week 4 was higher in the ultrasound-guided group (69.0% vs 47.4%; p = 0.01), with no significant difference at week 12 (p = 0.24). No serious adverse event was recorded. Both techniques provided clinical improvement through 12 weeks but ultrasound-guided paravertebral nerve root block conferred earlier analgesia and superior short-term functional improvement.