Epidural Adhesiolysis Research Articles

Transforaminal Epidural Neuroplasty for Chronic Low Back Pain due to Spinal Canal Stenosis

People all over the world suffer from persistent low back pain, often caused by spinal canal stenosis. In long term cases of spinal canal stenosis, perineural adhesions can form and that further exacerbates the pain. Transforaminal epidural adhesiolysis is beneficial as it breaks down the adhesions and allows more precise delivery of drug to the targeted area. We present a case of 57 years lady with complaint of low back pain for 2 years radiating to left leg and associated with heaviness of left leg after walking for 5 minutes. MRI report and her clinical features were suggestive of canal stenosis at L4 and L5 level. Percutaneous epidural neuroplasty was done using Racz catheter via transforaminal subpedicular approach at L4-L5 level. The numeric pain rating scale before procedure was 7/10 and after procedure decreased to 3/10. Her walking distance also increased to 45 minutes in 1 month after the procedure.

Analysis of the efficacy of retrodiscal approach percutaneous epidural adhesiolysis with WHIP catheter® in patients with lumbar radiculopathy: A retrospective study.

Percutaneous epidural adhesiolysis (PEA) is an effective treatment for patients with lumbar radiculopathy unresponsive to single steroid injections. Various approaches and instruments have been developed to access these lesions. This study aimed to evaluate the utility of a retrodiscal approach for epidural adhesiolysis using a WHIP catheter®. This retrospective study was conducted at Bundang Seoul National University Hospital, reviewing cases from January to December 2022. Forty-seven patients diagnosed with lumbar radiculopathy, aged 20 to 80 years, who underwent PEA with the WHIP catheter® were included. Outcomes assessed Numeric Rating Scale (NRS) for pain, Patients' Global Impression of Change (PGIC) scores, and the incidence of procedure-related complications. Follow-up evaluations occurred at 1, 3, and 6 months post-procedure. Among 47 patients, 41 completed the study, showing significant pain reduction at all follow-up points: 1 month (N = 41, 1.32 ± 1.68, P < .001), 3 months (N = 31, 1.90 ± 2.14, P < .001), and 6 months (N = 30, 2.50 ± 2.30, P < .001). PGIC scores indicated that 40% of the patients reported substantial improvement at one-month post-procedure. The complications were minimal, with only one case of intradiscal injection and 2 cases of vascular uptake. The retrodiscal approach PEA using the WHIP catheter® demonstrated significant efficacy in pain reduction with minimal safety concerns for patients with lumbar radiculopathy. These findings suggest that this procedure is a viable option for patients who are unresponsive to conservative treatment. However, the retrospective nature of this study and its small sample size necessitate further prospective controlled studies to confirm our results and establish long-term outcomes.

6. Persistent spinal pain syndrome type 2.

Persistent Spinal Pain Syndrome (PSPS) refers to chronic axial pain and/or extremity pain. Two subtypes have been defined: PSPS-type 1 is chronic pain without previous spinal surgery and PSPS-type 2 is chronic pain, persisting after spine surgery, and is formerly known as Failed Back Surgery Syndrome (FBSS) or post-laminectomy syndrome. The etiology of PSPS-type 2 can be gleaned using elements from the patient history, physical examination, and additional medical imaging. Origins of persistent pain following spinal surgery may be categorized into an inappropriate procedure (eg a lumbar fusion at an incorrect level or for sacroiliac joint [SIJ] pain); technical failure (eg operation at non-affected levels, retained disk fragment, pseudoarthrosis), biomechanical sequelae of surgery (eg adjacent segment disease or SIJ pain after a fusion to the sacrum, muscle wasting, spinal instability); and complications (eg battered root syndrome, excessive epidural fibrosis, and arachnoiditis), or undetermined. The literature on the diagnosis and treatment of PSPS-type 2 was retrieved and summarized. There is low-quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS-type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS-type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well-selected candidates with axial pain. The diagnosis of PSPS-type 2 is based on patient history, clinical examination, and medical imaging. Low-quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails.

Evaluation of the Efficacy of Caudal Epidural Neuroplasty in Patients With Lumbar Epidural Fibrosis.

Introduction Lumbar and leg pain can be caused by many factors, including scar tissue in the epidural space. Epidural fibrosis may cause chronic radicular low back pain. Adhesions in the epidural space may occur due to surgical or non-surgical reasons. Epidural adhesiolysis, i.e., neuroplasty, eliminates the pain-causing effects of scar tissue by releasing the nerve from the scar tissue or decompressing the nerve. In light of this information, this study was conducted to evaluate the effectiveness of percutaneous epidural neuroplasty interventions performed in the algology clinic in patients with lumbar epidural fibrosis who have and have not undergone lumbar surgery. Methods The sample of this retrospective study consisted of 72 patients with chronic radicular low back pain, finding fibrosis in the epidural region on contrast-enhanced magnetic resonance imaging (MRI), filling defect after epidurogram, and caudal epidural neuroplasty. Patients' visual analog scale (VAS) and Oswestry disability index (ODI) scores, pregabalin, duloxetine, and opioid doses were evaluated before and one month and six months after having neuroplasty. Results The VAS and ODI scores and pregabalin, duloxetine, and opioid doses decreased significantly in patients who had had caudal epidural neuroplasty at post-procedure endpoints compared to before the procedure (p<0.001). The paired temporal comparisons of the data of the patients who underwent epidural neuroplasty procedures before the procedure, one month after the procedure, and six months after the procedure revealed significant differences in the VAS and ODI scores (p<0.001). Additionally, the analysis of patients' VAS scores revealed that the pre-procedure VAS scores decreased significantly more one month after the procedure in patients without a history of lumbar surgery than in patients with a history of lumbar surgery. Conclusions The findings of our study demonstrated that fluoroscopy-guided percutaneous epidural neuroplasty alleviated pain and improved physical functions and quality of life. In conclusion, percutaneous epidural neuroplasty is a safe and effective treatment method for patients with lumbar epidural fibrosis.

Effect of runoff pattern contrast (RPC) on the long-term outcomes of epidural adhesiolysis using steerable catheters: A single-center observational study

Effect of runoff pattern contrast (RPC) on the long-term outcomes of epidural adhesiolysis using steerable catheters: A single-center observational study

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Cervical Angina as a Neglected Symptom of Cervical Spine Pathologies: Retrospective Observational Study

Objective: The objective is to assess the incidence of cervical angina as presentation of cervical spine pathologies. Materials and Methods: Data were collected retrospectively from patients’ medical records from January 2018 to December 2022 who presented to our pain clinic with chest pain, neck pain, upper extremity pain and tingling numbness. A total of 168 patients with cervical spine pathologies were identified. Those having chest pains were analyzed subsequently treated with pharmacotherapy, intramuscular stimulation (IMS). Cervical epidural adhesiolysis was performed depending on spine pathology based on clinical picture, severity of symptoms and radiological findings. Results: Among 168 patients 25 had chest pain. Out of 25 patients, 18 (72%) had chest pain as presenting symptom and 7 (28%) patients had associated chest pain. All 25 patients had cervical radiculopathy with or without nerve compression. Nerve root involved were C4 in 4 patients, C5 in 16 patients, C6 in 22 patients, and C7 in 8 patients, commonly involved were C5 and C6 with C4-C5 and C5-C6 prolapsed intervertebral disc. Thirteen patients (52%) were treated with pharmacotherapy and physiotherapy; seven (28%) patients had 2–3 sessions of IMS with pharmacotherapy. Five patients (20%) had undergone cervical epidural adhesiolysis, where conservative management failed. Conclusions: Even though cervical angina is an underdiagnosed disease, pain physicians and spine surgeons should be familiar with it for diagnosis and treatment. Cervical angina is associated with broad range of cervical spinal pathologies; the most common is cervical disc herniation. It can be easily diagnosed with high level of suspicion and treated with pharmacotherapy, IMS, and cervical epidural adhesiolysis.

Modified Epidural Adhesiolysis Protocol for the Treatment of Refractory Low Back Pain - A Case Series

BACKGROUND: Scar tissue can form within the epidural space following surgical trauma, infection, annular tearing, hematoma formation, and disc herniation. When epidural fibrosis (EF) is present, it can render nerve roots more susceptible to entrapment, compression, and tension—each of which can potentially contribute to low back and radicular pain in the lower extremities. In the past, several different epidural adhesiolysis protocols have been described to treat such pain. CASE REPORT: Three patients with chronic low back and radicular pain, and evidence of EF underwent a modified epidural adhesiolysis protocol over a single visit. All 3 patients reported greater than 50% pain relief for at least 3 months following treatment with the modified epidural adhesiolysis protocol. CONCLUSION: These case results suggest that the proposed modified epidural adhesiolysis can provide significant relief of axial and radicular pain in a cost effective and accessible manner for this patient population. KEY WORDS: Back pain, adhesiolysis protocol, vertebrogenic pain, epidural fibrosis, failed back surgery syndrome, post laminectomy syndrome

1. Lumbosacral radicular pain.

Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

Usefulness of cone-beam computed tomography-reformatted epidurography in percutaneous epidural adhesiolysis: A pilot study.

Conventional epidurography (CE) is thought to have insufficient usefulness on percutaneous epidural adhesiolysis (PEA). We aimed to evaluate the association between the outcome of PEA and cone-beam computed tomography-reformatted epidurography (CBCT-RE). After ethics board approval and written informed consent were obtained, we performed 30 PEA in 26 participants, and evaluated their post-PEA image findings. Two independent radiologists categorized and recorded the occurrence of contrast in the intracanal ventral and extraforaminal regions on CE, and in the dorsal canal (DC), ventral canal (VC), dorsal foramen (DF), and ventral foramen (VF) on CBCT-RE. Reproducibility was assessed using intraclass correlation coefficients (ICCs). Baseline characteristics along with contrast distribution patterns of CE and CBCT-RE were analyzed in terms of their association with symptom relief at 1 month after PEA. The rate of patients with symptoms relief >50% after PEA was 63.3%. The inter-reader agreement was higher for CBCT-RE (ICC = 0.955) than for CE (ICC = 0.793). Participants with contrast coexisting in VC and DF adjacent to the irritated nerve root on CBCT-RE ( p = 0.015) had a significantly better response after PEA than those without contrast at these locations on CBCT-RE, independent of baseline characteristics (adjusted odds ratio: 11.414 [ p = 0.012]). CBCT-RE with identifying contrast distribution patterns is useful for predicting outcome of PEA.

Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease.

Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.

Is Electrocatheter-Mediated High-Voltage Pulsed Radiofrequency of the Dorsal Root Ganglion an Effective Adjuvant to Epidural Adhesiolysis in the Treatment of Chronic Lumbosacral Radicular Pain? A Retrospective Analysis

This study aims to determine if high-voltage PRF could effectively adjunct epidural adhesiolysis (EA) in treating patients with chronic lumbosacral radiating pain (LSRP) and neuropathic characteristics. A total of 409 patients suffering from a single leg-radiating pain lasting for &gt; six months and unresponsive to previous treatments were divided into three different groups: Group 1 consisted of 227 patients suffering from LSRP in lumbar stenosis, 84 treated with EA alone and 143 with PRF-EA; group 2 consisted of 99 patients suffering from LSRP in FBSS (Failed Back Surgery Syndrome), 24 treated with EA alone and 75 with PRF-EA; group 3 consisted of 83 patients suffering for LSRP in discal herniation, 20 treated with EA and 63 with PRF-EA. NRS evaluated the outcome at rest and in movement, SF-12 Physical and Mental Health Summary Scales, and present pain intensity scale (PPI), before the treatment and at the 1-month follow-up for all the patients included in the study. Descriptive statistics (mean ± SD) were reported for NRSrest, NRSmov, PPI, PCS, and MCS scores. A dependent sample T-test was used to compare pre and post-treatment outcome measures (NRS, PPI, PCS, MCS), in patients treated for discal herniation, FBSS and stenosis, respectively. A potential difference in outcome between the different procedures performed in the three groups (EA + PRF versus EA alone) was analyzed by applying an independent two-tailed t-test. P value less than 0.05 represented a significant difference. A significant reduction of radiating pain was observed at one-month follow-up in NRSrest and NRSmov, PPI scores, for all the three groups of patients, independently of the treatment adopted (p &lt; 0.001). PCS12 and MCS12 significantly increased for all three groups of patients at 1-month follow-up (p &lt; 0.001). No significant differences in outcome were detected for both procedures (EA vs. PRF-EA) in all three groups (p &gt; 0.05). PRF and PRF-EA effectively reduce neuropathic pain intensity and improve the quality of life in patients who suffer from lumbosacral radiating pain in the context of lumbar stenosis, FBSS, or discal herniation. Adding pulsed radiofrequency (PRF) to epidural adhesiolysis alone does not improve the outcome.

Evaluation of percutaneous adhesiolysis for the management of chronic pain due to post spine surgery syndrome

ABSTRACT Background Failed back surgery syndrome (FBSS) is a persistent radicular and/or lumbar pain following spine surgery. Percutaneous adhesiolysis (PA) has proved efficacy for the treatment of intractable chronic pain after failure of conservative management. Aim Our research aims to investigate the effectiveness and safety of percutaneous epidural adhesiolysis using RACZ catheter as Numeric rating scale during 6-month duration as a primary outcome and catheter related complication as a secondary outcome among patients suffering chronic leg and low back pain in patients with failed back surgery syndrome. Methods 20 patients who were screened diagnosed as FBSS determined by MRI and patient symptoms during enrollment phase completed the study by passing Racz epidural catheter through Racz needle to the region of the filling defect. Results High statistically significant difference was found in NRS scores versus time in the study group when analyzed by Friedman test (P < 0.001) with 40%, 50%, 58% and 56% improvement in NRS at 2 weeks, 1 month, 3 months and 6 months, respectively. Conclusion Racz adhesiolysis is effective in improving pain scores in patients with FBSS after failure of conservative medical therapy.

Relationship between Time Elapsed Since Pain Onset and Efficacy of Pain Relief in Patients Undergoing Lumbar Percutaneous Epidural Adhesiolysis.

The aim of this study was to investigate the relationship between pain duration and pain relief after epidural adhesiolysis. Patients with low back pain who underwent lumbar epidural adhesiolysis were enrolled. A clinically significant reduction in pain score was defined as a ≥30% reduction at 6-month follow-up evaluation. Variables were compared based on pain duration categories. Changes in pain scores and pain outcome were also compared. Logistic regression analysis was conducted to identify factors associated with pain relief after adhesiolysis. A total of 169 patients, including 77 (45.6%) patients with a favorable pain outcome, were included for analysis. Patients with a pain duration ≥3 years reported lower baseline pain scores and showed more frequent severe central stenosis. Pain scores significantly decreased over time after the procedure except in patients with a pain duration ≥3 years. Most patients who experienced pain for ≥3 years showed poor pain relief (80.8%), unlike other pain duration categories (pain duration <3 months=48.1%, 3 months-1 year=51.8%, 1-3 years=48.6%). A pain duration ≥3 years and lower baseline pain score were independent factors associated with an unfavorable pain outcome. Pain lasting ≥3 years prior to lumbar epidural adhesiolysis was associated with worse outcomes in terms of pain relief. Therefore, this intervention should be considered early before pain chronification in patients with low back pain.

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Background &amp; Objective: The management of lumbar disc herniation (LDH) remains a big challenge as it may involve the surrounding tissues, and attract neovascularization facilitated macrophage aggregates. Epidural triamcinolone might have a half-life action ranging from 10 to 31 days, whereas 80 mg methylprednisolone might improve the pain up to 1 week. The higher doses of steroids will lead to adrenal cortex suppression and osteopenia. We evaluated the effect of treatment with 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at 2 weeks, and 3 and 6 months follow-up.&#x0D; Methodology: We enrolled seven males (38.9%) and 11 females (61.1%) with mean age 44 ± 23 y in the study. Eight (44.44%) subjects were younger than 51 y old, whereas the 10 (55.56%) subjects were ≥ 51 y old. Twelve (66.7%) subjects had had a bulged disc, and 6 (33.3%) subjects had disc protrusion. We injected 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at the site of disc lesion. Pain scores were measured with NRS scale and Oswestry Disability Index (ODI) scores at 2 weeks, and 3- and 6-months follow-up.&#x0D; Results: The NRS score improved at 2 weeks, 40% to 71.43%, at 3 months 60% to 100%, and 6 months 80% to 100%. And the Oswestry Disability Index (ODI) score was improved at 2 weeks from 23.5% to 68.18%), at 3 months from 39.13% to 100%, and at 6 months 82.35% to 100%. A significant association was observed between age older than 50 y old and ODI scores at 2 weeks followed up.&#x0D; Conclusions: The intra-epidural 1500 IU hyaluronidase before triamcinolone brings better results even though using a lower dose of triamcinolone. This approach showed the lower-cost better pain scores as compared to the routine use of heavy doses of triamcinolone for managing bulged and protruding LDH.

Computed Tomographic Epidurography in Patients with Low Back Pain and Leg Pain: A Single-Center Observational Study.

This study was conducted to analyze the findings and benefits of computed tomography (CT) epidurography in patients with low back and leg pain and compare these findings with those of magnetic resonance imaging (MRI) images. In total, 495 intervertebral discs from 99 patients with low back and leg pain who underwent percutaneous epidural adhesiolysis (epidural neuroplasty or percutaneous adhesiolysis) were examined. The axial views of CT epidurography were classified into six types to examine each intervertebral disc: round type, ellipse type, spike type, Benz mark, incomplete block, complete block, and non-contrast. MRI images were graded from A to D using the Schizas classification. Notably, 176 images were round-type and ellipse-type axial views, and 138 were spike-type and Benz-mark views; Schizas classification Grades A and B were observed in 272 and 47 MRI images, respectively. The incomplete block and complete block axial images did not significantly differ in CT epidurography and Schizas classification Grades C and D. The images showing Benz marks existed only at the L4/5 and L5/S intervertebral levels and only in 14.7% of patients. The ratio of normal shadows differed between MRI images and CT epidurography. Therefore, CT epidurography may enable a detailed evaluation of the epidural space.

Acute motor weakness of lower extremity after a novel balloon-inflatable catheter for percutaneous epidural adhesiolysis and decompression: A case report

Background: As our population ages and the rate of spine surgery continues to rise, the use of epidural lysis of adhesions has emerged as a popular treatment for spinal stenosis and disc herniation. Percutaneous Epidural Adhesiolysis (PEA) causes pain by preventing the release of increased spinal nerve movement and nerve sensitivity due to nerve compression. PEA and decompression with a newly developed inflatable balloon catheter have been widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. Case presentation: A 64-year-old female patient who had lower back pain and right buttock pain radiating to the leg caused by an L4- L5 severe spinal stenosis underwent PEA and decompression using a Zigzag-motion Inflatable Neuroplasty (ZiNeu®, JUVENUI, Seoul, Korea) catheter. After the procedure, the patient complained of acute motor weakness in the right leg. After conservative treatment, motor weakness and paresthesia gradually improved over time. At the follow-up visit after 3 weeks, there were no signs of motor or sensory abnormalities. Conclusions: Practitioners should be aware that these complications can occur at any time, and a skilled practitioner should undertake the procedure. Keywords: cute motor weakness; percutaneous epidural adhesiolysis and decompression; spinal stenosis. Abbreviations: HIVD: Herniated Intervertebral Disc; MRI: Magnetic Resonance Imaging; NRS: Numeric Rating Scale; ODI: Oswestry Disability Index; PEA: Percutaneous Epidural Adhesiolysis.

Contralateral retrodiscal transforaminal approach for percutaneous epidural adhesiolysis: A technical description and retrospective comparative study.

Retrodiscal transforaminal (RdTF) epidural steroid injection (ESI) is clinically comparable to conventional transforaminal ESI and can avoid catastrophic complications. However, it poses a risk of inadvertent intradiscal, intravascular, and intrathecal injections. Therefore, we aimed to evaluate the feasibility of percutaneous epidural adhesiolysis (PEA) using the contralateral (Contra)-RdTF approach. The electronic medical records of 332 patients with unilateral lumbar radiculopathy due to foraminal disk pathology were reviewed. Patients were categorized into two groups: Group A (ESI using the RdTF approach) and Group B (PEA using the Contra-RdTF approach). Effective pain relief (EPR; ≥50% pain relief from baseline) in patients was evaluated using the visual analog scale (VAS) at 4 and 12weeks after the procedure. The presence of unintended fluoroscopic findings and complications was recorded. A total of 119 patients were enrolled in the final analysis: 81 in Group A and 38 in Group B. Both groups showed lesser VAS scores after 4 and 12weeks than at baseline (p<0.05). However, the proportion of patients with EPR was significantly greater in Group B after 12weeks (p=0.015). No complications, including intrathecal injection, infectious discitis, and neurologic deterioration, were reported. However, inadvertent intradiscal and intravascular injections were reported to be significantly higher in Group A than in Group B (14.8% and 0%, respectively; p=0.009). Although applications of this study are limited by its retrospective design, the results suggest that PEA using the Contra-RdTF approach is feasible because it can achieve EPR and avoid unintended fluoroscopic findings.

Особенности физической реабилитации пациентов с грыжами межпозвонковых дисков, которым проводился эпидуральный адгезиолиз

Актуальность. По данным многих авторов, в 40–75 % наблюдений пояснично-крестцовая боль обусловлена диск-радикулярным конфликтом. Повторные обострения в течение года возникают у 30–70 % пациентов, а 5–15 % из них нуждаются в хирургическом лечении. Но хирургическое лечение не всегда решает вопрос снижения болевого синдрома. В последнее время все большую популярность приобретает метод эпидурального адгезиолиза. Цель: оценить эффективность применения средств физической реабилитации в восстановительном лечении пациентов с грыжами межпозвонковых дисков, перенесших процедуру эпидурального адгезиолиза. Материалы и методы. Проанализированы данные 105 пациентов, проходивших стационарное лечение в отделении реабилитации ГУ «Институт травматологии и ортопедии НАМН Украины». Основная группа (n = 55) пациентов проходила курс эпидурального адгезиолиза и программу физической реабилитации. Контрольная группа (n = 50) проходила курс процедур эпидурального адгезиолиза. Оценку болевого синдрома проводили на основании ВАШ. Для оценки степени нарушения жизнедеятельности использовано анкетирование Оswestry Disability Index (ODI). Повторное наблюдение проводили через 1, 3, 6 месяцев после лечения. Результаты. Результаты анкетирования по ODI подтвердили более высокую эффективность в основной группе при повторном обследовании через 6 месяцев (23,0 ± 2,5 балла, р &lt; 0,05). Результаты повторного обследования в контрольной группе по данным шкалы Оswestry ухудшились (28,0 ± 2,8 балла, р &lt; 0,05). По результатам ВАШ прослеживается четкая достоверная разница в отдаленных результатах лечения между основной и контрольной группами через 6 месяцев: соответственно 2,9 ± 0,2 см в основной группе и 3,8 ± 0,4 см в контрольной группе (р &lt; 0,05 ). Выводы. Систематическое применение упражнений в сочетании с процедурой эпидурального адгезиолиза позволяет повысить эффективность лечения пациентов с грыжами и протрузиями межпозвонковых дисков на этапах реабилитации, что подтверждается результатами исследований.

Метод епідурального адгезіолізу в лікуванні пацієнтів із поперековим спінальним стенозом

Актуальність. Дегенеративний поперековий спінальний стеноз (ПСС) — хронічний процес, що з часом призводить до зменшення розміру кістково-зв’язкового футляра хребта й супроводжується наступною клінічною симптоматикою — нейрогенною (каудогенною) переміжною кульгавістю (caudicatio intermittens), ішіасом, м’язовою слабкістю в нижніх кінцівках, а також іншими вертеброгенними симптомами. Мета дослідження: визначити ефективність застосування епідурального адгезіолізу в лікуванні симптомів ПСС, а також оцінити ступінь ефективності цього методу лікування за наявності супутніх дегенеративних деформацій поперекового відділу хребта (дегенеративний сколіоз, дегенеративний спондилолістез). Матеріали та методи. Проаналізовано дані 148 пацієнтів (69 чоловіків і 79 жінок) віком від 60 до 92 років, які пройшли курс лікування й спостерігалися протягом року у відділенні реабілітації ДУ «Інститут травматології та ортопедії НАМН України». Методи дослідження: кількісна та якісна оцінка больового синдрому за візуальною аналоговою шкалою болю; оцінка якості життя за результатами анкет Роланда-Морріса і Оswestry. Індекс видужання, що характеризує ступінь відновлення після консервативного лікування, був розрахований для кожного пацієнта через 7 днів після процедури, а також через 6 міс. після проведеного лікування. Результати. Після застосування епідурального адгезіолізу та кінезотерапії відзначено статистично значуще (р &lt; 0,05) поліпшення стану пацієнтів групи 1 (діагноз: ПСС). У пацієнтів групи 2 (діагноз: ПСС і дегенеративний сколіоз) і групи 3 (діагноз: ПСС і спондилолістез) результати консервативного лікування були значно гіршими як на первинному, так і на віддаленому етапі спостережень. Висновки. За результатами спостережень на віддалених етапах виявлено, що консервативне лікування (епідуральний адгезіоліз і кінезотерапія) не усуває спінального стенозу і не змінює структуру спинномозкового каналу, але дозволяє усунути практично всі його прояви й уникнути операції. Наявність деформації хребта і спондилолістезу в пацієнтів із ПСС дозволяє виділити їх у групу несприятливих факторів, що впливають на результати лікування.