Analgesic Efficacy of Epidural Neuroplasty via Racz Catheter During Lumbar Fixation In Situ for Lumbosacral Spondylolisthesis: A Randomized Controlled Trial

Epidural steroid injections (ESIs) are widely employed for managing low back pain (LBP), particularly when conservative treatment fails. The Racz catheter technique offers targeted drug delivery and mechanical adhesiolysis, potentially enhancing outcomes in chronic LBP. The present study aimed to compare the Racz catheter technique and the conventional technique in lumbar epidural steroid injection for the management of LBP. This randomized, controlled, double-blind study was conducted on a sample of 60 patients, aged 18 - 65, comprising both sexes, who had persistent lumbar pain, grade 1 spondylolisthesis, and facet osteoarthropathy with small disc findings on radiological examination. Participants were randomized equally into two groups. The Racz catheter group received lumbar epidural steroids using a Racz catheter, while the conventional lumbar group received conventional lumbar steroid injections. The Visual Analog Scale (VAS) and Oswestry Low Back Disability Questionnaire (OSW) scores were insignificantly different at baseline, immediately post-procedure, and at 1 month between both groups. However, they were significantly lower at 2 months, 4 months, and 6 months in the Racz catheter group compared to the conventional lumbar group (P < 0.05). Incidences of hypotension, paraesthesia, bleeding, and headache were insignificantly different between both groups. Patient satisfaction levels were significantly higher in the Racz catheter group than in the conventional lumbar group (P < 0.05). The Racz catheter technique is a superior interventional option for lumbar epidural steroid delivery in patients with persistent LBP, providing enhanced pain relief, improved functional outcomes, greater patient satisfaction, and equivalent procedural safety compared to the conventional technique.

Background: Epidural neuroplasty using a Racz catheter has a therapeutic effect. Studies have found no correlation between foraminal stenosis and the outcome of epidural neuroplasty, which is thought to depend on contrast runoff. Objective: To examine the correlation between the contrast spread pattern and pain reduction in cervical epidural neuroplasty using a Racz catheter. Study Design: Retrospective study. Setting: An interventional pain-management practice in a university hospital. Methods: Fluoroscopic images were reviewed retrospectively. The spread of contrast from the neural foramen to a nerve root was called contrast runoff. If the contrast did not spread in this manner, then there was no contrast runoff. We defined successful epidural neuroplasty as a 50% or greater reduction from the pre-procedure numeric rating scale (NRS) score for total pain, and an at least 40% reduction in the neck pain and disability scale (NPDS) score. Results: This study reviewed 169 patients. Among the patients who had a contrast runoff pattern, the epidural neuroplasty was rated as successful in 96 (74.4%), 97 (75.2%), 86 (66.7%), and 79 (61.2%) cases one, 3, 6, and 12 months after the procedure, respectively. When there was no contrast runoff, the epidural neuroplasty was successful in 12 (30%), 12 (30%), 10 (25%), and 10 (25%) cases at one, 3, 6, and 12 months after the procedure (P &lt; 0.001). Logistic regression of the contrast spread pattern and predicting successful epidural neuroplasty gave similar results. Patients with a contrast runoff pattern had odds ratios of 6.788, 7.073, 6.000, and 4.740 at one, 3, 6, and 12 months, respectively (P &lt; 0.001). Limitations: This study lacked a control group, and the patients were not classified by their diagnosed disease, such as spinal stenosis, herniated nucleus pulposus, and post-spinal surgery syndrome. Conclusions: Cervical epidural neuroplasty with a contrast runoff pattern had a higher success rate. Contrast runoff should be observed during neuroplasty, even in the presence of foraminal stenosis. Key words: Cervical spinal pain, contrast, contrast runoff, epidural neuroplasty, percutaneous adhesiolysis, Racz catheter

Background: Epidural neuroplasty using the Racz catheter has a therapeutic effect in patients with cervical disc herniation and central stenosis who do not respond to fluoroscopically guided epidural injections. Objective: To evaluate the clinical outcomes of cervical epidural neuroplasty in patients with posterior neck and upper extremity pain and to demonstrate correlations between predictive factors and unsuccessful results of cervical epidural neuroplasty. Study Design: Observational study. Setting: An interventional pain management practice in a university hospital. Methods: Outcome measures were obtained using the numeric rating scale (NRS) for total pain, neck pain, arm pain, and sleep disturbance; and the neck pain and disability scale (NPDS); as well as opioid consumption at preprocedure, one month, 3, 6, and 12 months after procedure. Successful epidural neuroplasty was defined as 50% or greater reduction from the preprocedure NRS for total pain, and at least a 40% reduction in the NPDS. We obtained clinical data and radiologic findings to evaluate correlations between predictive factors and efficacy of epidural neuroplasty. Results: Of the 169 patients, successful outcomes were observed in 108 patients (63.9%) at one month following the procedure, in 109 patients (64.5%) at 3 months, in 96 patients (56.8%) at 6 months, and in 89 patients (52.7%) at 12 months. Previous surgery, spondylolisthesis, and ossification of the posterior longitudinal ligament were significantly associated with unsuccessful outcomes as measured by NRS and NPDS (P &lt; 0.05). Limitations: Limitations of this evaluation include the lack of a placebo group. Conclusions: Cervical epidural neuroplasty may be an effective treatment for pain reduction and functional improvement in patients with cervical spinal pain who did not respond to conservative treatment, and may decrease surgical demand. Previous surgery, spondylolisthesis, and ossification of the posterior longitudinal ligament are associated with unsuccesful outcomes of epidural neuroplasty. Key words: Cervical spinal pain, epidural neuroplasty, percutaneous adhesiolysis, predictive factor, racz catheter

Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. Complications of epidural neuroplasty are due to the procedure itself or due to specific drugs-related side effects. Unintended dural puncture, administration of the drugs to the subarachnoid or subdural space, catheter shearing, infection and severe hemodynamic instability during application are most commonly observed adverse events. Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.

BackgroundPercutaneous epidural neuroplasty with a Racz catheter is widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. The breakage or shearing of an epidural catheter, particularly a percutaneous epidural neuroplasty catheter, is reported as a rare complication. There has been a controversy over whether surgical removal of a shorn epidural catheter is needed. Until now, only three cases related to sheared Racz neuroplasty catheters have been reported. We report a case of a neuroplasty catheter which completely broke when it was inserted into the epidural space, and compressed root symptoms were exacerbated by the broken catheter.Case presentationA 68-year-old Asian man with leg pain and lower back pain caused by lumbar vertebral body 4 to lumbar vertebral body 5 intervertebral disc herniation and stenosis underwent percutaneous epidural neuroplasty. During the procedure, the epidural neuroplasty catheter was trapped in the left foraminal portion and broke. Our patient complained of left-side leg pain and numbness. Surgery performed to remove the broken catheter led to complete resolution of his leg pain and numbness.ConclusionsWe report a rare case of catheter breakage occurring during epidural neuroplasty. We suggest surgical removal because the implanted catheter can aggravate a patient’s symptoms and lead to the development of neurologic deficits due to infection, fibrosis, or mechanical neural irritation.

Patient satisfaction regarding their hip replacement is often assumed to be directly linked to functional outcomes. We led this study to answer 2 questions: (1) what is the level of patient satisfaction, function, and quality of life after primary total hip replacement (THR); and (2) what is the relationship between patient satisfaction and functional and quality of life PROMs after THR? We led a retrospective study using our institutional registry of prospectively and consecutively collected data on patients after primary THR undertaken between 2004 and 2017. We included 6710 patients with a complete 2-year set of follow-up data for Oxford Hip Score (OHS) (for assessing patient's function), EQ-5D (for assessing patient's quality of life) and satisfaction PROM scores. There was a significant improvement in all OHS and EQ-5D scores from preoperative level, and the mean postoperative satisfaction score was 89/100. We found moderate positive correlations between the patients' outcome satisfaction VAS score and OHS (r = 0.665) and EQ-5D (r = 0.554). THR is a successful procedure generating high levels of patient function and satisfaction. Because patients' OHS and EQ-5D scores may be influenced by comorbidities, those scores are of poor predictive value in estimating patient satisfaction, and therefore should not be used as a surrogate to determine the success of the THR procedure.

BackgroundBreakage of balloon-less Racz neuroplasty catheters is a rare complication of neuroplasty; however, shearing of balloon catheters during epidural neuroplasty has not been reported.CaseHerein, we report a case of a broken epidural balloon catheter during neuroplasty. A 76-year-old female underwent percutaneous epidural neuroplasty (PEN) using a Racz catheter, epidural steroid injection, and medial branch block for lumbar spinal stenosis 6 months ago. However, her symptoms did not improve. Subsequently, we performed a PEN using an inflatable balloon catheter. During the procedure, the epidural balloon catheter became trapped, broke, and could not be retrieved. Subsequently, the patient complained of leg pain and numbness. Therefore, surgery was performed to remove the broken catheter, resolving the leg pain and numbness.ConclusionsThis case report supports the surgical removal of broken catheters to avoid the aggravation of symptoms and the development of neurological deficits.

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.

THU0491 RELIABILITY AND VALIDITY OF THE İSTANBUL LOW BACK PAIN DISABILITY INDEX IN LUMBAR RADICULOPATHY

The application of new technologies for analysis of retinal images, neural networks for automated retinopathy grading, and teleophthalmology have been shown to have great value in ophthalmology. India has only one ophthalmic surgeon for every 107,000 population. Given this situation, teleophthalmology can play a vital role in addressing to the eye care needs of the country. The objective of this study was to assess patient satisfaction levels and factors influencing it during teleophthalmology consultation in India. A patient satisfaction questionnaire was prepared to assess the prominent aspects of patient satisfaction, including teleophthalmology screening, confidence in the technology used to transfer the fundus images, comprehensiveness of information available to the doctor in the central hub, and graded the opinion regarding the teleophthalmology. A cross-sectional survey among patients who attended a teleophthalmology screening conducted across eight villages in rural Tamilnadu. Responses were then subjected to qualitative analysis and conclusions made. The number of respondents was 348. Of this, 56.4% were males. The mean age of was 50 +/- 17 years. Age ranged from 2 years to 83 years. 44.4% of the respondents were satisfied with teleophthalmology screening. (95% confidence interval [CI]: 38.58%-49.42%) No association was found between age, gender, education, and occupation, respectively, with satisfaction levels. We found that patients who asked questions during the screening were 2.18 times more likely to be satisfied with teleophthalmology than those who did not (odds ratio [OR] = 2.19, 95% CI 1.37-3.5). This study highlights sentiments of the rural subjects when they underwent teleophthalmology consultations. This study provides valuable insights about patient's preferences and satisfaction levels with this newer technology.

Introduction: The use of antiretroviral therapy (ART) in HIV management has closed the gap in life expectancies between Persons Living with HIV (PLHIV) and the general populace, leading to longevity among PLHIVs. However, increased life expectancies or longevity do not translate to better treatment satisfaction and Quality of Life (QoL). Available literature indicates a divergence in findings with regards the effect of ART on patient satisfaction levels and QoL. With dolutegravir (DTG)-based regimens currently the mainstay of HIV management, there is the need to ascertain effects of DTG on patient satisfaction and QoL among PLHIV. Thus, the aim of this study is to review the existing literature and pool the patient satisfaction levels and QoL among PLHIV exposed to DTG. Methods: This is a systematic review and meta-analysis. Study outcomes will be the mean values of the QoL, as well as the proportions, odds ratios and risk ratios of patient satisfaction with DTG. Searches will be conducted on PubMed and Scopus databases, with search period limited to the last 10 years. Studies that reported on the effect of DTG on our outcomes of interest will be included. For studies where the study population was exposed to other integrase strand transfer inhibitors or other ART classes, we will collect data separately for the outcomes of those exposed to DTG and those of the comparator. Also, included studies will be peer-reviewed articles that utilized standardized assessment tools to evaluate QoL among PLHIV exposed to DTG. Conversely, this review will exclude case studies, commentaries, editorials, and all forms of reviews. The study will employ the Preferred Reporting Items for Systematic Review and Meta-analysis checklist. Data extraction and screening will be conducted by 4 independent reviewers. Quality assessment will be conducted using the Newcastle Ottawa Scale. Further, narrative synthesis will be conducted as well as a random effect meta-analysis to pool estimates of patient satisfaction and QoL among PLHIV. All statistical analysis will be performed using the R Studio v 4.2.1. Results: Findings from this study will be presented at relevant theme-specific conferences and published in a peer-reviewed journal. Conclusion: Given the global adoption of DTG-based regimens as the mainstay of current treatment guidelines, a comprehensive systematic review focusing on the effects of DTG on patient satisfaction and QoL is required. This study will represent the first study to present the estimates of patient satisfaction levels and QoL among PLHIVs exposed to DTG. Our review will provide a background for clinical decision-making and patient-centred policies. Protocol Registration: This systematic review and meta-analysis protocol was registered on 6 February 2025 on PROSPERO with the identification number, CRD42025643301.

Background/Aim: Our aim was to investigate the effect of on-line HDF versus high-flux (HF) hemodialysis (HD) on a patient's health-related satisfaction level. Methods: Overall, 72 patients, on regular low-flux HD for 51 ± 26 month mean age of 54 ± 12 years, were randomized to HF (group 1, n = 36) and to HDF (group 2, n = 36) and followed up for 24 months. Assessment was based on the patient's satisfaction level using modified questionnaires of the validated Kidney Disease Quality of Life-Short Form (KDQOL-SF) version 1.3. Results: The HDF group achieved a higher satisfaction level than the HF group (p < 0.0001) with less cramps (3 ± 5 vs. 55 ± 8), itching (9 ± 10 vs. 48 ± 10), joint pain and stiffness (24 ± 10 vs. 83 ± 8), and improvement in general mood (94 ± 9 vs. 28 ± 16), sexual performance (57 ± 10 vs. 5 ± 5), and social activity (82 ± 9 vs. 15 ± 8). Conclusion: High-efficiency postdilution on-line HDF versus high-flux HD significantly improved patients' satisfaction and quality of life, including social, physical, and professional activities.

BackgroundIdiopathic Inflammatory Myopathies (IIM) are the group of rare diseases that carry a significant impact on patient's quality of life, influenced by the level of patient's satisfaction regarding medical services.ObjectivesTo...

Satisfaction with care in peritoneal dialysis patients