Ist eine epidurale Injektionsbehandlung mit hypertoner Kochsalzlösung beim Bandscheibenvorfall sinnvoll? (Die Wirkung von NaCl-Lösung auf Bandscheibengewebe)

Abstract

The effect of sodium chloride solution on disc tissue was investigated in vitro. Tissue material was obtained from 19 discectomies. The specimens were incubated in aqua ad injectionem and in different sodium chloride solutions and weighted regularly during a maximum of 24 hours. Following the incubation periods the specimens were examined histologically. After one hour the surgical specimens showed a weight increase of 290% for aqua bidest., 170% for 0.9% NaCl and 100% for 5.85% NaCl and 10% NaCl. Disc tissue obtained from six autopsies was also examined under the same conditions. The weight increase in nucleus pulposus and anulus fibrosus tissue was less than in the disc tissue obtained from surgery. The weight increase in anulus fibrosus tissue was less than in nucleus pulposus tissue. In vitro incubation of disc tissue in a hypermolar sodium chloride solution always resulted in a weight increase. Successful therapy could not be explained by shrinkage of disc tissue treated with hypermolar sodium chloride.

Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

“…[ 3 6 19 30 58 66 67 68 89 95 96 99 118 119 139 140 148 155 158 167 168 181 185 190 191 ] In addition, the efficacy of sodium chloride solution injected into joint spaces or the epidural space has also been described. [ 10 16 17 60 200 ] All the studies demonstrated the efficacy of local anesthetic with steroids; although the disc herniation group showed higher quality with pain relief improvement at 6 and 12 months. One of the major advantages of these trials was that only patients with chronic pain were enrolled and patient homogeneity was observed by recruiting those with similar diagnoses/conditions instead of lumping all diagnostic groups together and/or including those with acute and subacute pain.…”

“…The findings of this systematic review may be explained by various mechanisms of steroids and local anesthetics, including the suppression of ectopic discharges from inflamed nerves, enhancing blood flow to ischemic nerve roots, the lysing of iatrogenic and inflammatory adhesions, a washout of proinflammatory cytokines, and reversal of peripheral and central sensitization. [ 10 30 47 58 60 68 77 89 95 96 179 190 198 200 ] Bicket et al . [ 12 ] hypothesized a placebo effect with epidural injections, especially those administered via the transforaminal approach, often with reproduction of radicular symptoms, which is not observed with soft tissue injections, resulting in high levels of placebo effect and undermining the effectiveness of blinding.…”