Does improvement in epidurography following percutaneous epidural neuroplasty correspond to patient outcome?

Abstract

The positive effects of percutaneous epidural neuroplasty (PEN) likely result from elimination of fibrous tissue. However, a direct link between epidural adhesions and pain symptoms is debatable. We tested the hypothesis that epidurographic improvements correspond to improved patient outcome. In this prospective study, patients with a filling defect on initial epidurography underwent PEN. Two weeks later, contrast agent distribution around the target area was assessed with repeat epidurography. A successful treatment was defined as over a 50% reduction in visual analog scale (VAS) score 2weeks postprocedure. The demographic data, history of lumbar spine operation, target nerve, diagnosis, VAS scores, degree of epidurographic improvement, and patient satisfaction were compared between the successful treatment group (Group I) and unsuccessful treatment group (Group II). Seventy-nine patients were included. Epidurographic findings improved in 67.1% of patients 2weeks after the procedure. Following PEN, the mean VAS scores of all patients were significantly decreased at 2weeks (4.12±2.34), 1month (3.56±2.30), 3months (3.84±2.45), and 6months (4.13±2.71) compared with the initial scores (7.82±1.78). In the comparison between Groups I and II, the rate of epidurographic improvement in Group I was higher than in Group II (P=0.022). Satisfaction in patients that had epidurographic improvement (median satisfaction: 4) was higher than in patients that did not have epidurographic improvement (median satisfaction: 3; P=0.003). The epidurographic changes following PEN correlate with patient-assessed pain relief and satisfaction.