Percutaneous Epidural Neuroplasty Research Articles

A Comparative Study of Endoscopic versus Percutaneous Epidural Neuroplasty in Lower Back Pain: Outcomes at Six-Month Follow Up.

Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.

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.

Spinal Injections: A Narrative Review from a Surgeon's Perspective.

Spinal pain is one of most frequent complaints of the general population, which can cause decreased activities of daily living and absence from work. Among numerous therapeutic methods, spinal injection is one of the most effective treatments for spinal pain and is currently widely applied in the clinical field. In this review, spinal injection is discussed from a surgeon's perspective. Recently, although the number of spinal surgeries has been increasing, questions are arising as to whether they are necessary. The failure rate after spinal surgery is high, and its long-term outcome was reported to be similar to spinal injection. Thus, spinal surgeries should be performed conservatively. Spinal injection is largely divided into diagnostic and therapeutic blocks. Using diagnostic blocks, such as the diagnostic selective nerve root block, disc stimulation test, and diagnostic medial branch block (MBB), the precise location causing the pain can be confirmed. For therapeutic blocks, transforaminal nerve root injection, therapeutic MBB, and percutaneous epidural neuroplasty are used. When unbearable spinal pain persists despite therapeutic spinal injections, spinal surgeries can be considered. Spinal injection is usefully used to identify the precise location prior to a patient undergoing injection treatment or surgery and can reduce pain and improve quality of life, and help to avoid spinal surgery. Pain physicians should treat patients with spinal pain by properly utilizing spinal injection.

Inadvertent Intrathecal Contrast Injection during Percutaneous Epidural Neuroplasty: Two Autopsy Cases

Percutaneous epidural neuroplasty (PEN) is an interventional technique used to manage spinal pain. However, the procedure may lead to various complications, such as dural puncture and inadvertent intrathecal injection of contrast agents. Conventional autopsy techniques may have limitations in identifying these complications, but postmortem computed tomography (PMCT) scans may be helpful in this respect. The pseudosubarachnoid hemorrhage sign on a PMCT scan is an important finding that suggests an inadvertent intrathecal injection of a contrast agent during the procedure. Here, we report on two rare cases of intrathecal contrast injection that mimicked a subarachnoid hemorrhage after PEN. These rare cases should be considered during autopsies of PEN-related deaths, and a PMCT scan should always be performed prior to such autopsies.

Risk Factors for Conversion to Open Spinal Surgery after Percutaneous Epidural Neuroplasty

Risk Factors for Conversion to Open Spinal Surgery after Percutaneous Epidural Neuroplasty

Effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with chronic spinal stenosis accompanying mild spondylolisthesis: a longitudinal cohort study.

Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. Patients' sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

Percutaneous epidural balloon neuroplasty: a narrative review of current evidence.

Percutaneous epidural balloon neuroplasty (PEBN) can be used to perform balloon decompression combined with percutaneous epidural neuroplasty (PEN), leading to significant pain relief and functional improvement in patients with lumbar spinal stenosis. Several studies have demonstrated the effectiveness of PEBN and supported its relatively long-term outcomes (at least 6 months, sustained for up to 12 months). Balloon neuroplasty appears to be superior to conventional PEN. Moreover, it has been shown to be effective in patients unresponsive to conventional PEN or in those with post lumbar surgery syndrome. In addition, balloon neuroplasty achieved successful outcomes regardless of the approach used, such as retrodiscal, transforaminal, contralateral interlaminar, or caudal. Chronic lumbar radicular pain without back pain, neurogenic claudication, and minimal neuropathic component were favorable predictors of successful PEBN from a symptomatic perspective. A short duration of pain after lumbar surgery, lumbar foraminal stenosis caused primarily by degenerative disc, mild foraminal stenosis, and perineural adhesion by degenerative discs were associated with successful outcomes of PEBN from pathological aspects. Ballooning ≥ 50% of the target sites and complete contrast dispersion after ballooning seemed to be crucial for successful outcomes from a technical perspective. In addition, PEBN was effective regardless of the accompanying redundant nerve roots or a mild degree of spondylolisthesis. Studies on balloon neuroplasty have reported occasional minor and self-limiting complications; however, no PEBN-related significant complications have been reported. Given the present evidence, balloon neuroplasty appears to be a safe and effective procedure with minimal complications for the treatment of lumbar spinal stenosis.

Comparison of Clinical Results between Percutaneous Epidural Neuroplasty and Trans-Foraminal Epidural Block for Lumbar Foraminal Stenosis

Comparison of Clinical Results between Percutaneous Epidural Neuroplasty and Trans-Foraminal Epidural Block for Lumbar Foraminal Stenosis

Percutaneous epidural adhesiolysis – treatment method for drug-resistant back pain

Introduction: Percutaneous epidural adhesiolysis (epidural decompressive neuroplasty, percutaneous epidural neuroplasty) is treatment method for drug-resistant back pain, including post-surgery syndrome, sciatica or spinal canal stenosis. Aim: To describe the method and outcomes of epidural adhesiolysis. Material and methods: The review of the literature on the topic of epidural adhesiolysis. Results and discussion: This procedure is usually performed in the lumbo-sacral part of the spine, although it can be also done in the cervical or thoracic parts as well. Its purpose is to administer anesthetic drugs, steroids, saline solution or hyaluronidase into the epidural space via one of the three approaches: caudal, interlaminar and transforaminal. The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. Conclusions: The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. When performed by an experienced physician, epidural adhesiolysis is a safe and effective method with infrequent adverse events.

Spinal cord injury during cervical percutaneous epidural neuroplasty.

Spinal cord injury during cervical percutaneous epidural neuroplasty.

The effect of additional transforaminal epidural blocks on percutaneous epidural neuroplasty with a wire-type catheter: A retrospective observational study.

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN between(1)the Runoff group and the Non-runoff group,(2)the Runoff group and the Transforaminal group, and(3)the Non-runoff group and the Transforaminal group.The success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.

Clinical Effectiveness of Percutaneous Epidural Neuroplasty According to the Type of Single-Level Lumbar Disc Herniation : A 12-Month Follow-Up Study.

ObjectiveTo determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH. MethodsThis study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom’s criteria) were assessed at 1, 3, 6, and 12 months after treatment. ResultsThe mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom’s criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1–3 (14.0–21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05). ConclusionOur findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

Contrast Dispersion on Epidurography May Be Associated with Clinical Outcomes After Percutaneous Epidural Neuroplasty Using an Inflatable Balloon Catheter.

Contrast dispersion pattern on epidurography may be associated with clinical improvement after epidural neuroplasty. However, insufficient evidence supports this theory. The current study aims to evaluate the relevance of contrast dispersion and clinical improvement after percutaneous epidural neuroplasty using an inflatable balloon catheter. One hundred patients with lumbar spinal stenosis who underwent combined balloon decompression and epidural adhesiolysis between March 2015 to December 2015 participated in the present study. Participants were divided into two groups by contrast dispersion pattern on postprocedural epidurography: the complete contrast dispersion (CCD) and incomplete contrast dispersion (ICCD) groups. The numeric rating scale (NRS), Oswestry Disability Index (ODI), and global perceived effects (GPE) were each assessed before and one, three, six, nine, and 12 months after the intervention. After combined balloon decompression and adhesiolysis, significant pain reduction and functional improvement were maintained up to 12 months in patients with lumbar spinal stenosis. NRS and GPE in the CCD group were significantly lower than in the ICCD group from six to 12 months after the intervention. The ODI in the CCD group was also significantly lower compared with that in the ICCD group from one to 12 months after the intervention. Combined balloon decompression and adhesiolysis with the inflatable balloon catheter can provide noteworthy pain reduction and improvement of physical function for a long-term period in patients with lumbar spinal stenosis. Because CCD showed better clinical improvement compared with ICCD, a contrast dispersion pattern may be associated with an improved clinical outcome.

The Effect of Additional Transforaminal Epidural Blocks in Percutaneous Epidural Neuroplasty

The Effect of Additional Transforaminal Epidural Blocks in Percutaneous Epidural Neuroplasty

WITHDRAWN:Comparison of the Efficacy of Epidural Balloon Neuroplasty Versus Percutaneous Epidural Neuroplasty Using a Catheter for Lumbar Central Spinal Stenosis.

This article was withdrawn by the Neurospine editorial board's decision due to the author's ethical problem.

PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

Efficacy of Epidural Balloon Neuroplasty According to Spondylolisthesis Grade

Background: Degenerative spondylolisthesis (DS) is the most common causes of mechanical compression of spinal nerve roots. The compression of these nerve roots can lead to low back pain and/or leg pain, as well as neurogenic claudication. Percutaneous epidural neuroplasty (PEN) or balloon neuroplasty (BNP) are established treatment for lumbar spinal pain. Objective: The aim of our study was to determine the efficacy of BNP according DS grading. Methods: This study enrolled 107 patients with grade 1 DS (n=56) or grade 2 DS (n=51). Outcome measures were obtained by using both the visual analogue scale score (VAS) for pain and Oswetry instability index (ODI) at 2 weeks, and 6 months after treatment. Limitations: Grade 3 or 4 were not included. Secondary outcomes were not assessed, and the study did not include a long-term follow up period. Results: Mean post-treatment VAS at 2 weeks and 6 months were not significantly lower in either the patients with DS 1or the patients with DS 2. In addition, difference between the two groups were not significant. Among the patients with DS1, 37% of patients had VAS > 50% at both 2 weeks and 6 months follow up. Among the patients with DS 2, 17.9% and 21% had VAS >50% at 2 weeks and 6 months follow up assessment, respectively. In the DS 1 group, there was significant correlation between pain duration and at 2 weeks using VAS. Three patients with DS 1 and three with DS 2 had done surgery after BNP. Conclusion: BNP was not a suitable treatment modality for patients with grade 1and 2 DS at the 6-month followup period.

Clinical Significance of Epidurography Contrast Patterns after Adhesiolysis during Lumbar Percutaneous Epidural Neuroplasty.

Background The correlation between epidurography contrast patterns and the clinical outcomes of percutaneous epidural neuroplasty (PEN) remains unclear. Objective To analyze the correlation between postadhesiolysis epidurography contrast patterns and the clinical outcomes of patients who undergo lumbar PEN. Design This study is a retrospective analysis of 78 consecutive patients who underwent lumbar PEN between April 2012 and March 2013. Setting The analysis was done in the university hospital center. Method The clinical outcomes of all patients were assessed before and 1, 3, 6, and 12 months after undergoing lumbar PEN. Specifically, the intensity of back and leg pain, quality of life, and procedural outcomes were evaluated using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the 12-Item Short-Form Health Survey (SF-12). Results The VAS scores for back and leg pain, ODI score, and SF-12 score exhibited a significant improvement during the follow-up period (P < 0.01 versus preprocedural scores). At most follow-up time points, patients exhibiting extraforaminal contrast distribution (n=22) on postadhesiolysis epidurograms exhibited a similar improvement in VAS scores and a significantly better improvement in ODI and SF-12 scores compared with patients exhibiting intracanal contrast distribution (n=56). Conclusion Extraforaminal contrast distribution during lumbar PEN may be associated with better functional outcomes.

Clinical Course of Cervical Percutaneous Epidural Neuroplasty in Single-Level Cervical Disc Disease with 12-Month Follow-up

Background: Cervical disc disease is a common and occasionally disabling condition, occurring as a natural consequence of aging in the vast majority of the adult population. Percutaneous epidural neuroplasty (PEN) has been used to deliver highly concentrated drugs for chronic neck pain and to prevent scarring in cases refractory to conventional epidural blocks. However, the clinical course after PEN in cervical disc disease is not well-documented. Objective: The purpose of this study was to evaluate the efficacy of cervical PEN for single-level cervical disc disease. Study Design: A retrospective observational study. Methods: A consecutive series of 100 patients who underwent cervical PEN for single-level disc disease (bulging or protrusion) were included in this study. Preoperatively, all patients underwent magnetic resonance imaging (MRI), and visual analog scale (VAS) scores as well as Odom’s criteria were measured preoperatively and at post-operative follow-up visits (one, 3, 6, and 12 months). Limitations: The results of this study are limited by the lack of a control group that did not undergo treatment with PEN. Results: Additional block therapy was performed in 58 patients (58.0%). Subsequent surgery was performed in 10 patients (10.0%, excluded from data of clinical follow-up). Mean neck pain and VAS arm pain scores for all follow-up patients decreased from 6.82 and 4.74 preoperatively to 2.18 and 1.87 at 12 months after PEN (P &lt; 0.001). More than 80% and 40% of all patients with and without additional block therapy after cervical PEN, respectively, showed good and excellent outcomes according to Odom’s Criteria during 12 months of follow-up. During this follow-up period, no severe complications related to the procedure were observed. Conclusion: Cervical PEN was shown to be a safe and effective treatment for neck and arm pain in single-level disc disease during 12 months of follow-up.

Spinal cord injury after percutaneous epidural neuroplasty with anticoagulation therapy in elderly patient

Spinal cord injury after percutaneous epidural neuroplasty with anticoagulation therapy in elderly patient