Chan Hong Park1, Sang Ho Lee2. 1. Department of Anesthesiology and Pain Medicine, Spine Health Wooridul Hospital, Daegu, South Korea. 2. Department of Neurosurgery, Spine Health Wooridul Hospital, Seoul, South Korea.
Abstract
Background: Spinal stenosis is characterized by narrowing of the spinal canal, with mechanical compression of spinal nerve roots. The latter may cause low back pain and/or leg pain, as well as neurogenic claudication. Epidural steroid injection is commonly used to treat patients with lumbar spinal stenosis (LSS), but percutaneous epidural adhesiolysis has been utilized when symptoms prove refractory. Our goal was to assess the relationship between improvement shown on epidurogram and subjective patient response to adhesiolysis. Methods: For this prospective study, 78 patients with degenerative LSS were enrolled. Each subject underwent magnetic resonance imaging of the lumbar spine, with all therapeutic procedures conducted in the operating room. Two weeks later, a second epidurography was performed. Second epidurography was conducted to assess any change in epidural filling defects. Outcome measures were obtained using the visual analogue scale (VAS) score at two weeks, one month, and three months post-treatment. Results: All of the 78 study participants (mean age = 60.9 years, range = 34-85 years) displayed epidural filling defects at baseline. After percutaneous adhesiolysis, epidurographic filling defects were absent in 73% of patients. In the presence or absence of filling defects, mean VAS scores were 5.2 and 4.5, respectively, at two weeks' follow-up. No significant correlation between postprocedural VAS score and status of filling defects (yes or no) was evident during the three-month follow-up period. Conclusion: In patients with LSS, epidurographic findings following percutaneous epidural adhesiolysis failed to correlate with level of pain reduction achieved.
Background: Spinal stenosis is characterized by narrowing of the spinal canal, with mechanical compression of spinal nerve roots. The latter may cause low back pain and/or leg pain, as well as neurogenic claudication. Epidural steroid injection is commonly used to treat patients with lumbar spinal stenosis (LSS), but percutaneous epidural adhesiolysis has been utilized when symptoms prove refractory. Our goal was to assess the relationship between improvement shown on epidurogram and subjective patient response to adhesiolysis. Methods: For this prospective study, 78 patients with degenerative LSS were enrolled. Each subject underwent magnetic resonance imaging of the lumbar spine, with all therapeutic procedures conducted in the operating room. Two weeks later, a second epidurography was performed. Second epidurography was conducted to assess any change in epidural filling defects. Outcome measures were obtained using the visual analogue scale (VAS) score at two weeks, one month, and three months post-treatment. Results: All of the 78 study participants (mean age = 60.9 years, range = 34-85 years) displayed epidural filling defects at baseline. After percutaneous adhesiolysis, epidurographic filling defects were absent in 73% of patients. In the presence or absence of filling defects, mean VAS scores were 5.2 and 4.5, respectively, at two weeks' follow-up. No significant correlation between postprocedural VAS score and status of filling defects (yes or no) was evident during the three-month follow-up period. Conclusion: In patients with LSS, epidurographic findings following percutaneous epidural adhesiolysis failed to correlate with level of pain reduction achieved.