Open AccessTransforaminal Epiduroscopy in Patients with Failed Back Surgery Syndrome
Author(s) -
Martı́n Avellanal
Publication year - 2019
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/2019.22.89
Subject(s) - medicine , failed back surgery , radicular pain , surgery , lateral recess , intervertebral foramen , foramen , pulsed radiofrequency , low back pain , disc herniation , back pain , spinal stenosis , intervertebral disc , nerve root , lumbar , spinal cord stimulation , stimulation , pain relief , alternative medicine , pathology
Background: Epiduroscopy is a useful diagnostic and therapeutic tool for managing failedback surgery syndrome (FBSS). The conventional approach is via either the sacral hiatus or theinterlaminar. Major causes of FBSS include epidural fibrosis, disc herniation, and stenosis. Whenthese problems are located at the intervertebral foramen level, it can be difficult to reach the lateralrecess and the foramen with the epiduroscope. Transforaminal epiduroscopy could be a usefulalternative approach in patients with FBSS located at the foraminal level.Objective: We present a new procedure for lumbar epiduroscopy via a transforaminal approachand its application in patients with FBSS. The technique is described and long-term results arereported.Study Design: This study used a single-arm prospective observational design.Setting: The research took place at the University Hospital in Spain.Methods: Patients with FBSS suffering severe chronic radicular pain (Numeric Rating Scale [NRS11] > 7) who had not responded to other treatments were included. Selective root stimulationduring a pulsed radiofrequency procedure confirmed the origin of pain by means of an exactreproduction of typical pain. Transforaminal epiduroscopy was performed at the affected level.The severity of fibrosis observed was recorded. The NRS-11 score was reevaluated at 1, 6, and 12months after the procedure. Any complications related to the treatment were recorded.Results: Twenty-four patients were included. The mean number of back surgeries was 1.66(range, 1-5). The basal NRS-11 score was 7.83 (0.14); at 1 month, 3.66 (0.38) (P < 0.001); at 6months, 4.46 (0.48) (P < 0.01); and at 1 year after treatment, 4.17 (0.51) (P < 0.01). Most patients(54%; 95% CI, 34%-74%) obtained > 50% pain reduction on the NRS-11, maintained during a1-year follow-up period. No major complications were registered.Limitations: The research was limited by the lack of a control group.Conclusions: We have described a new procedure for epiduroscopy via the transforaminalapproach. It is a useful and safe approach to managing FBSS at the foraminal level and showsbetter long-term results than other endoscopic procedures.Key words: Epidural, epiduroscopy, chronic pain, spinal cord, back surgery