Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

Abstract

Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ) at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P = 0.007). The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P = 0.02). Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.

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.…”

Reliability of the Michigan State University (Msu) Classification of Lumbar Disc Herniation

“…However, axial cut image at the pathological level is given sole priority by the MSU classification system which is periodically practiced by authors around the world to optimize management strategies for patients with lumbar disc herniations. 2 , 10 – 12 The concept of considering a single axial cut image at the level of maximal herniation may be unlike the “Lumbar disc nomenclature: version 2.0” where sagittal images are taken into consideration; 13 even so, the MSU classification clearly defines the shape, location and extent of the disc herniation.…”

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

“…In addition to obvious masses and canal narrowing, microscopic adhesions, which may be a result of chronic inflammation, can interrupt the spread of drugs. Although numerous studies have described PEN procedures, only a few have reported intraoperative findings that indicate the surgical outcomes [ 11 , 13 , 14 , 17 – 19 ]. Epidurography is always performed during PEN procedures, but there is insufficient evidence supporting the usefulness of this procedure.…”