Open AccessEffectiveness of Percutaneous Transforaminal Adhesiolysis in Patients with Lumbar Neuroforaminal Spinal Stenosis
Author(s) -
Chan Hong Park
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e37
Subject(s) - medicine , neurogenic claudication , spinal stenosis , percutaneous , surgery , magnetic resonance imaging , low back pain , lumbar , lumbar spinal stenosis , epidural steroid injection , stenosis , back pain , nerve root , radiology , anesthesia , alternative medicine , pathology
Background: Lumbar foraminal spinal stenosis (LFSS) is a narrowing of the bony exit of a nerveroot, which causes mechanical compression of spinal nerve roots. Low back pain and/or legpain, and possibly neurogenic claudication, may result due to mechanical neural compression.Transforaminal epidural steroid injections (TFESIs) are commonly used for treating LFSS. Patientsrefractory to TFESIs may benefit from percutaneous epidural adhesiolysis.Objective: Our intent was to assess transforaminal adhesiolysis (TFA) as treatment for LFSS,analyzing patient response by severity of stenosis and evaluating the short-term effectivenessof TFA.Study Design: Prospective study.Methods: Following IRB approval, 35 patients with LFSS were enrolled, all of whom underwentmagnetic resonance imaging (MRI) of the lumbar spine. Sagittal MRI views were evaluated tograde the severity of LFSS. TFA was routinely conducted in the operating room. One hour afterthe procedure, each patient received 6 mL of 10% sodium chloride, infused over 30 minutes,with monitoring. Posttreatment outcomes were determined at 2 weeks and 3 months using a5-point patient satisfaction scale. To test predictive value, patients were stratified by response(improvement versus no improvement).Results: Improvement (defined as little pain, moderate pain, or no pain) was observed in 25patients (71.4%) at 2 weeks and in 22 patients (62.8%) at 3 months following the procedure.Among patients showing improvement, those with Grade 3 spinal stenosis outnumbered thosewith Grade 2. At the 3-month follow-up, no statistically significant correlations between painrelief and the grade of LFSS was evident.Limitations: Secondary outcomes were not measured and the follow-up period was relativelybrief.Conclusion: Short-term results indicate that percutaneous TFA is an effective treatment forLFSS, although therapeutic outcomes and the severity of LFSS showed no correlation.Key words: Lumbar, foraminal stenosis, adhesiolysis, effectiveness.