Clinical Significance of Epidurography Contrast Patterns after Adhesiolysis during Lumbar Percutaneous Epidural Neuroplasty

Abstract

Background The correlation between epidurography contrast patterns and the clinical outcomes of percutaneous epidural neuroplasty (PEN) remains unclear. Objective To analyze the correlation between postadhesiolysis epidurography contrast patterns and the clinical outcomes of patients who undergo lumbar PEN. Design This study is a retrospective analysis of 78 consecutive patients who underwent lumbar PEN between April 2012 and March 2013. Setting The analysis was done in the university hospital center. Method The clinical outcomes of all patients were assessed before and 1, 3, 6, and 12 months after undergoing lumbar PEN. Specifically, the intensity of back and leg pain, quality of life, and procedural outcomes were evaluated using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the 12-Item Short-Form Health Survey (SF-12). Results The VAS scores for back and leg pain, ODI score, and SF-12 score exhibited a significant improvement during the follow-up period (P < 0.01 versus preprocedural scores). At most follow-up time points, patients exhibiting extraforaminal contrast distribution (n=22) on postadhesiolysis epidurograms exhibited a similar improvement in VAS scores and a significantly better improvement in ODI and SF-12 scores compared with patients exhibiting intracanal contrast distribution (n=56). Conclusion Extraforaminal contrast distribution during lumbar PEN may be associated with better functional outcomes.

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

“…Based on the search criteria, 13 manuscripts were identified and considered for inclusion [ 18 , 25 , 31 - 41 ]. A total of 6 studies met the inclusion criteria [ 25 , 31 , 33 , 37 , 38 , 40 ].…”

“…Of the 6 manuscripts meeting inclusion criteria [ 25 , 31 , 33 , 37 , 38 , 40 ], there was only one placebo-controlled RCT [ 25 ]. Appendix Tables 4 and 5 show the methodologic quality assessment and risk of bias of the one RCT utilizing the Cochrane review criteria and the IPM-QRB criteria respectively [ 27 , 28 ].…”

“…Based on the search criteria, 13 manuscripts were identified and considered for inclusion [18,25,[31][32][33][34][35][36][37][38][39][40][41]. A total of 6 studies met the inclusion criteria [25,31,33,37,38,40]. Of the 6 studies included, 2 of them [18,41] studied disc prolapse, along with post-lumbar surgery syndrome, and subgroup data analysis was not available.…”

Clinical Efficacy and Safety of Trans-Sacral Epiduroscopic Laser Decompression Compared to Percutaneous Epidural Neuroplasty

“…Previous studies have shown that PEN with or without epiduroscopy demonstrated superior effectiveness compared with both physical therapy and caudal epidural injections [3, 4]. Its advantages extend beyond adhesiolysis to include drug delivery to areas of pathology that occur in diseases such as HLD or stenosis [1, 2]. Especially epiduroscopic adehisoilysis had good outcome regarding adhesiolysis even if postlumbar surgery syndrome or failed back surgery syndrome had severe adhesion [14–16].…”

“…Percutaneous epidural neuroplasty (PEN) is a minimally invasive therapy for spinal diseases [1–4]. Although it was originally developed to treat postoperative adhesion, PEN has also been used for targeted drug delivery, epidural scarring, and neural decompression [1, 4]. Additionally, the procedure has shown good clinical outcomes as a herniated lumbar disc (HLD) treatment when compared to physiotherapy [3].…”