Efficacy of Epidural Neuroplasty Versus Transforaminal Epidural Steroid Injection for the Radiating Pain Caused by a Herniated Lumbar Disc

Abstract

ObjectiveTo compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc.MethodsThirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment.ResultsIn the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00±1.52, 4.29±1.20, 2.64±0.93, 1.43±0.51 and those of FRI were 23.57±3.84, 16.50±3.48, 11.43±2.44, 7.00±2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22±2.05, 4.28±1.67, 2.56±1.04, 1.33±0.49 and those of FRI were 22.00±6.64, 16.22±5.07, 11.56±4.18, 8.06±1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically.ConclusionEpidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

Factors Associated with Successful Response to Balloon Decompressive Adhesiolysis Neuroplasty in Patients with Chronic Lumbar Foraminal Stenosis

“…However, in these refractory cases, epidural neuroplasty, often called percutaneous epidural adhesiolysis, is currently performed using a shear-resistant catheter (the Racz-type catheter) or with a more steerable navigation catheter [3,4]. The effectiveness of percutaneous epidural neuroplasty is relatively well-established in these chronic refractory cases [5,6]. There are also previously investigated factors like hyaluronidase administrated, large volume injection and using hypertonic saline to favor a successful procedure outcome [7].…”

The effect of additional transforaminal epidural blocks on percutaneous epidural neuroplasty with a wire-type catheter

“…[9] Lumbar epidural adhesions occur most frequently postoperatively or because of fibrocyte deposition or inflammatory responses to intervertebral disc extrusion into the epidural space. [10] Adhesion physically prevents the spread of drugs around the nerves. [11] According to previous study, [12] PEN is a minimally invasive and more effective treatment for patients with epidural adhesions because a catheter is placed directly at the epidural adhesion area.…”

Percutaneous epidural balloon neuroplasty: a narrative review of current evidence

“…More invasively, lysis of adhesion can be performed by epiduroscopy with direct visualization of the pathology [ 5 ]. The effectiveness of PEN for the treatment of chronic refractory symptoms in degenerative spinal diseases is relatively well-established [ 1 , 6 , 13 ]. However, the long-term effects (i.e., over six months) of conventional PEN using Racz catheter, NaviCath, and EpiStim are uncertain and unclear [ 14 ].…”