Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Effectiveness of Percutaneous Epidural Neuroplasty According to the Type of Single-Level Lumbar Disc Herniation : A 12-Month Follow-Up Study

  • Cho, Pyung Goo (Department of Neurosurgery, Ajou University College of Medicine) ;
  • Ji, Gyu Yeul (Department of Neurosurgery, Cham Teun Teun Research Institute) ;
  • Yoon, Young Sul (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Shin, Dong Ah (Department of Neurosurgery, Yonsei University College of Medicine)
  • Received : 2019.03.15
  • Accepted : 2019.05.18
  • Published : 2019.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH. Methods : This study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom's criteria) were assessed at 1, 3, 6, and 12 months after treatment. Results : The mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom's criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1-3 (14.0-21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05). Conclusion : Our findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

Keywords

References

  1. Canale ST BJ : Campbell's operative orthopaedics. Philadelphia : Elsevier, 2003
  2. Carey TS, Garrett JM, Jackman AM : Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain. Spine (Phila Pa 1976) 25 : 115-120, 2000 https://doi.org/10.1097/00007632-200001010-00019
  3. Carragee EJ, Han MY, Suen PW, Kim D : Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85 : 102-108, 2003 https://doi.org/10.2106/00004623-200301000-00016
  4. Chopra P, Smith HS, Deer TR, Bowman RC : Role of adhesiolysis in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician 8 : 87-100, 2005
  5. Epter RS, Helm S 2nd, Hayek SM, Benyamin RM, Smith HS, Abdi S : Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician 12 : 361-378, 2009
  6. Franklin CVJ, Kalirathinam D, Palekar T, Nathani N : Effectiveness of PNF training for chronic low back pain. IOSR JNHS 2 : 41-52, 2013 https://doi.org/10.9790/1959-0244152
  7. Han YJ, Lee MN, Cho MJ, Park HJ, Moon DE, Kim YH : Contrast runoff correlates with the clinical outcome of cervical epidural neuroplasty using a racz catheter. Pain Physician 19 : E1035-E1040, 2016
  8. Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, Smith HS : Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician 12 : 419-435, 2009
  9. Heavner JE, Racz GB, Raj P : Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase. Reg Anesth Pain Med 24 : 202-207, 1999 https://doi.org/10.1016/S1098-7339(99)90128-1
  10. Helm Ii S, Benyamin RM, Chopra P, Deer TR, Justiz R : Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain Physician 15 : E435-E462, 2012
  11. Ji GY, Oh CH, Moon B, Choi SH, Shin DA, Yoon YS, et al. : Efficacy of percutaneous epidural neuroplasty does not correlate with dural sac cross-sectional area in single level disc disease. Yonsei Med J 56 : 691-697, 2015 https://doi.org/10.3349/ymj.2015.56.3.691
  12. Lee JH, Lee SH : Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician 15 : 213-221, 2012
  13. Manchikanti L, Bakhit CE : Percutaneous lysis of epidural adhesions. Pain Physician 3 : 46-64, 2000 https://doi.org/10.36076/ppj.2000/3/46
  14. Manchikanti L, Boswell MV, Datta S, Fellows B, Abdi S, Singh V, et al. : Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician 12 : E123-E198, 2009
  15. Manchikanti L, Boswell MV, Singh V, Benyamin RM, Fellows B, Abdi S, et al. : Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 12 : 699-802, 2009
  16. Manchikanti L, Cash KA, McManus CD, Pampati V, Singh V, Benyamin R : The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial. Pain Physician 12 : E341-E354, 2009
  17. Manchikanti L, Manchikanti KN, Gharibo CG, Kaye AD : Efficacy of percutaneous adhesiolysis in the treatment of lumbar post surgery syndrome. Anesth Pain Med 6 : e26172, 2016
  18. Manchikanti L, Pampati V, Fellows B, Rivera J, Beyer CD, Damron KS : Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial. Pain Physician 4 : 153-166, 2001
  19. Manchikanti L, Pampati V, Fellows B, Rivera JJ, Damron KS, Beyer C, et al. : Effectiveness of percutaneous adhesiolysis with hypertonic saline neurolysis in refractory spinal stenosis. Pain Physician 4 : 366-373, 2001
  20. Manchikanti L, Singh V, Bakhit CE, Fellows B : Interventional techniques in the management of chronic pain: part 1.0. Pain Physician 3 : 7-42, 2000 https://doi.org/10.36076/ppj.2000/3/7
  21. Manchikanti L, Singh V, Cash KA, Pampati V, Datta S : A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. Pain Physician 12 : E355-E368, 2009
  22. Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, et al. : Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 6 : 3-81, 2003
  23. Oh CH, Ji GY, Cho PG, Choi WS, Shin DA, Kim KN, et al. : The catheter tip position and effects of percutaneous epidural neuroplasty in patients with lumbar disc disease during 6-months of follow-up. Pain Physician 17 : E599-E608, 2014
  24. Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, et al. : Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356 : 2245-2256, 2007 https://doi.org/10.1056/NEJMoa064039
  25. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N : MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology 230 : 583-588, 2004 https://doi.org/10.1148/radiol.2302021289
  26. Splendiani A, Puglielli E, De Amicis R, Barile A, Masciocchi C, Gallucci M : Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. Neuroradiology 46 : 916-922, 2004 https://doi.org/10.1007/s00234-004-1232-0
  27. Taheri A, Khajenasiri AR, Nazemian Yazdi NA, Safari S, Sadeghi J, Hatami M : Clinical evaluation of percutaneous caudal epidural adhesiolysis with the racz technique for low back pain due to contained disc herniation. Anesth Pain Med 6 : e26749, 2016
  28. Trainor TJ, Wiesel SW : Epidemiology of back pain in the athlete. Clin Sports Med 21 : 93-103, 2002 https://doi.org/10.1016/S0278-5919(03)00059-0
  29. Trescot AM, Chopra P, Abdi S, Datta S, Schultz DM : Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update. Pain Physician 10 : 129-146, 2007
  30. Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior HJ : Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial. J Orthop Sci 11 : 365-369, 2006 https://doi.org/10.1007/s00776-006-1032-y
  31. Viesca CO, Racz GB, Day MR : Special techniques in pain management: lysis of adhesions. Anesthesiol Clin North Am 21 : 745-766, vi, 2003 https://doi.org/10.1016/S0889-8537(03)00088-9

Cited by

  1. Comments on "The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis" vol.35, pp.1, 2019, https://doi.org/10.3344/kjp.2022.35.1.124