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Kose HC, Akkaya OT. Predictive Factors Associated with Successful Response to Percutaneous Adhesiolysis in Chronic Lumbar Radicular Pain. J Clin Med 2023; 12:6337. [PMID: 37834981 PMCID: PMC10573688 DOI: 10.3390/jcm12196337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous adhesiolysis (PEA) is of interest in the treatment of lumbar radicular pain. This study aimed to assess the effectiveness of PEA in patients with chronic lumbar radicular pain refractory to epidural steroid injections and to determine predictive factors, including demographic, clinical, and procedural data, to provide superior treatment efficacy. One hundred and ninety-three patients were reviewed. Successful treatment outcome was described as a 50% reduction in the visual analog scale score. Among the 193 patients, 109 (56.2%) exhibited a positive treatment response at 12 months. In multivariate logistic regression analysis, no depression (OR, 3.105; 95% CI, 1.127-8.547; p = 0.028), no spondylolisthesis (OR, 2.976; 95% CI, 1.246-7.092; p = 0.014), no previous lumbar surgery (OR, 2.242; 95% CI, 1.067-4.716; p = 0.033), mild foraminal stenosis (OR, 3.460; 95% CI, 1.436-8.333; p = 0.006), no opioid use (OR, 1.782; 95% CI, 0.854-3.717; p = 0.123), and baseline pain scores (OR, 0.787; 95% CI, 0.583-1.064; p = 0.120) were the predictive factors significantly associated with unsuccessful treatment outcome. PEA is a useful treatment option for patients with chronic lumbar radicular pain refractory to epidural steroid injections. A history of lumbar surgery, spondylolisthesis, depression, and severe foraminal stenosis could be associated with a poor prognosis.
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Affiliation(s)
- Halil Cihan Kose
- Department of Pain Medicine, Kocaeli City Hospital, 41060 Kocaeli, Turkey
| | - Omer Taylan Akkaya
- Department of Pain Medicine, Health Science University Etlik City Hospital, 06120 Ankara, Turkey;
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Shin DA, Choo YJ, Chang MC. Spinal Injections: A Narrative Review from a Surgeon's Perspective. Healthcare (Basel) 2023; 11:2355. [PMID: 37628553 PMCID: PMC10454431 DOI: 10.3390/healthcare11162355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
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.
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Affiliation(s)
- Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea;
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Nam-gu, Daegu 42415, Republic of Korea;
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Nam-gu, Daegu 42415, Republic of Korea;
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Kim DH, Shin JW, Choi SS. Percutaneous epidural balloon neuroplasty: a narrative review of current evidence. Anesth Pain Med (Seoul) 2022; 17:361-370. [DOI: 10.17085/apm.22237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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Kim JY, Lee YH, Yoo S, Kim JY, Joo M, Park HJ. Factors Predicting the Success of Adhesiolysis Using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study. J Clin Med 2021; 10:jcm10050913. [PMID: 33652702 PMCID: PMC7956797 DOI: 10.3390/jcm10050913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure.
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Oh Y, Shin DA, Kim DJ, Cho W, Na T, Leem JG, Shin JW, Kim DH, Hahm KD, Choi SS. Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study. J Clin Med 2020; 9:jcm9041144. [PMID: 32316281 PMCID: PMC7230941 DOI: 10.3390/jcm9041144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
Post-laminectomy syndrome (PLS) is characterized by chronic pain and complex pathological entity after back surgery. An epidural adhesiolysis is considered an effective treatment option for lumbar PLS. In this study, we retrospectively analyzed the outcome and evaluated the predictive factors of combined epidural adhesiolysis and balloon decompression using inflatable balloon catheters in lumbar PLS cases. One hundred and forty-seven subjects were retrospectively assessed and analyzed. The percentages of patients who exhibited treatment response were 32.0%, 24.5%, and 22.4% of the study population at 1, 3, and 6 months, respectively. In multivariate logistic regression analysis, the pain duration was independently associated with the treatment response six months after combined epidural adhesiolysis and balloon decompression (odds ratio = 0.985, 95% confidence interval = 0.971-0.999; p = 0.038). In addition, the receiver operating characteristic curve analysis showed that the area under the curve of pain duration after lumbar surgery was 0.680 (95% confidence interval = 0.597-0.754, p = 0.002), with an optimal cut-off value of ≤14 months, sensitivity of 51.5%, and specificity of 81.4% Our results suggest that an early intervention using combined epidural adhesiolysis and balloon decompression in lumbar PLS patients may be associated with a favorable outcome, even though it has limited effectiveness.
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Affiliation(s)
- Yul Oh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Woojong Cho
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Taejun Na
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
| | - Kyung-Don Hahm
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
- Correspondence: (K.-D.H.); (S.-S.C.); Tel.: +82-2-3010-5979 (K.-D.H.); Tel.: +82-2-3010-1538 (S.-S.C.)
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.O.); (D.J.K.); (W.C.); (T.N.); (J.-G.L.); (J.-W.S.); (D.-H.K.)
- Correspondence: (K.-D.H.); (S.-S.C.); Tel.: +82-2-3010-5979 (K.-D.H.); Tel.: +82-2-3010-1538 (S.-S.C.)
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Kim CS, Moon YJ, Kim JW, Hyun DM, Son SL, Shin JW, Kim DH, Choi SS, Karm MH. Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations. J Clin Med 2020; 9:jcm9040981. [PMID: 32244742 PMCID: PMC7230206 DOI: 10.3390/jcm9040981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here.
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Affiliation(s)
- Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Yeon-Jin Moon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Korea; (Y.-J.M.); (S.L.S.)
| | - Jae Won Kim
- Department of Anesthesiology and Pain Medicine, Eulji University Medical Center, Eulji University College of Medicine, Daejeon 35233, Korea;
| | - Dong-Min Hyun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Shill Lee Son
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Korea; (Y.-J.M.); (S.L.S.)
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
- Correspondence: (S.-S.C.); (M.-H.K.); Tel.: +82-2-3010-1538 (S.-S.C.); +82-2-2072-3847 (M.-H.K.)
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul 03080, Korea
- Correspondence: (S.-S.C.); (M.-H.K.); Tel.: +82-2-3010-1538 (S.-S.C.); +82-2-2072-3847 (M.-H.K.)
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