Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

다국어 초록 (Multilingual Abstract)

Objective To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure.
Methods This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months’ duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score.
Results ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point.
Conclusion Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.

참고문헌 (Reference)

1 Manchikanti L., "Transforaminal lumbar epidural steroid injections" 3 : 374-398, 2000

2 Yousef AA, "The role of adding hyaluronidase to fluoroscopically guided caudal steroid and hypertonic saline injection in patients with failed back surgery syndrome: a prospective, double-blinded, randomized study" 10 : 548-553, 2010

3 Manchikanti L, "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" 12 : E341-E354, 2009

4 Hartrick CT, "The numeric rating scale for clinical pain measurement: a ratio measure?" 3 : 310-316, 2003

5 Porter RW, "The natural history of root entrapment syndrome" 9 : 418-421, 1984

6 Jinkins JR, "The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion" 152 : 1277-1289, 1989

7 Fairbank JC, "The Oswestry Disability Index" 25 : 2940-2952, 2000

8 김상범, "The Effect of Hyaluronidase in Interlaminar Lumbar Epidural Injection for Failed Back Surgery Syndrome" 대한재활의학회 36 (36): 466-473, 2012

9 김상범, "The Additional Effect of Hyaluronidase in Lumbar Interlaminar Epidural Injection" 대한재활의학회 35 (35): 405-411, 2011

10 Epter RS, "Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome" 12 : 361-378, 2009

11 Trescot AM, "Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update" 10 : 129-146, 2007

12 Fukusaki M, "Symptoms of spinal stenosis do not improve after epidural steroid injection" 14 : 148-151, 1998

13 Jenis LG, "Spine update: lumbar foraminal stenosis" 25 : 389-394, 2000

14 Chopra P, "Role of adhesiolysis in the management of chronic spinal pain: a systematic review of effectiveness and complications" 8 : 87-100, 2005

15 Bogduk N., "On the definitions and physiology of back pain, referred pain, and radicular pain" 147 : 17-19, 2009

16 Amundsen T, "Lumbar spinal stenosis. Clinical and radiologic features" 20 : 1178-1186, 1995

17 Manchikanti L, "Lumbar facet joint nerve blocks in managing chronic facet joint pain: one-year follow-up of a randomized, double-blind controlled trial: Clinical Trial NCT00355914" 11 : 121-132, 2008

18 Smith CC, "Interlaminar versus transforaminal epidural steroid injections for the treatment of symptomatic lumbar spinal stenosis" 11 : 1511-1515, 2010

19 Rabinovitch DL, "Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain" 9 : 509-517, 2009

20 Cooper RG, "Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration" 20 : 591-598, 1995

21 Choi E, "Evaluation of prognostic predictors of percutaneous adhesiolysis using a Racz catheter for post lumbar surgery syndrome or spinal stenosis" 16 : E531-E536, 2013

22 Frank Lee, "Epidural Lysis of Adhesions" 대한통증학회 27 (27): 3-15, 2014

23 Thomas E, "Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia: a prospective, randomised, double-blind study" 22 : 299-304, 2003

24 Kim SH, "Effects of transforaminal balloon treatment in patients with lumbar foraminal stenosis: a randomized, controlled, double-blind trial" 16 : 213-224, 2013

25 Rivest C, "Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study" 11 : 291-297, 1998

26 Kobayashi S, "Effects of arterial ischemia and venous congestion on the lumbar nerve root in dogs" 26 : 1533-1540, 2008

27 Manchikanti L, "Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain" 15 : E199-E245, 2012

28 Manchikanti L, "Effectiveness of percutaneous adhesiolysis with hypertonic saline neurolysis in refractory spinal stenosis" 4 : 366-373, 2001

29 Park CH, "Dural sac cross-sectional area does not correlate with efficacy of percutaneous adhesiolysis in single level lumbar spinal stenosis" 14 : 377-382, 2011

30 Kunogi J, "Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression" 16 : 1312-1320, 1991

31 Talu GK, "Complications of epidural neuroplasty:a retrospective evaluation" 6 : 237-247, 2003

32 Lee JH, "Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis" 25 : 206-210, 2009

33 Lee JH, "Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome" 39 : 214-218, 2014

34 Lee JH, "Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation" 15 : 213-221, 2012

35 Lee JH, "Clinical effectiveness of percutaneous adhesiolysis and predictive factors of treatment efficacy in patients with lumbosacral spinal stenosis" 14 : 1497-1504, 2013

36 Boden SD, "Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects: a prospective investigation" 72 : 1178-1184, 1990

37 Manchikanti L, "A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617]" 5 : 10-, 2005

38 Manchikanti L, "A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections" 15 : 131-140, 2012