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Park S, Park JH, Jang JN, Choi SI, Song Y, Kim YU, Park S. Pulsed radiofrequency of lumbar dorsal root ganglion for lumbar radicular pain: A systematic review and meta-analysis. Pain Pract 2024. [PMID: 38294072 DOI: 10.1111/papr.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) of the lumbar dorsal root ganglion (DRG) has been widely used as a method to relieve lumbar radicular pain (LRP). However, the value of PRF application in LRP patients remains uncertain. This systematic review aimed to compare the effects of PRF of lumbar DRG and LEI in patients with LRP. METHODS A literature search was performed using well-known databases for articles published up to May 2023. We included randomized controlled trials (RCTs) that evaluated the effects of PRF compared to LEI with or without steroids. We screened articles, extracted data, and assessed risk of bias in duplicate. The pain scores and Oswestry Disability Index (ODI) scores at 1, 3, and 6 months after procedures were obtained. A random-effects meta-analysis model was applied for outcomes. We evaluated evidence certainty for each outcome using the GRADE scoring system. This review was registered in the PROSPERO (ID: CRD42021253628). RESULTS A total of 10 RCTs were included and data of 613 patients were retrieved. We assessed the overall quality of the evidence as very low to moderate. PRF showed no difference in pain scores at 1 (mean difference [MD] -0.80, 95% confidence interval [CI] -1.59 to 0.00, low certainty) and 6 months (MD -2.37, 95% CI -4.79 to 0.05, very low certainty), and significantly improved pain scores at 3 months (MD -1.31, 95% CI -2.29 to -0.33, low certainty). There was no significant difference in ODI score at any interval (very low to low certainty). In the subgroup who underwent a diagnostic block, did not use steroids, and PRF duration greater than 360 s, PRF significantly reduced pain scores at 3 months after procedures. CONCLUSIONS We found low quality of the evidence supporting adjuvant PRF to the lumbar DRG has a greater analgesic effect at 3 months after procedures in patients with LRP than LEI. We identified no convincing evidence to show that this treatment improves function. High-quality evidence is lacking, and data were largely derived from short-term effects. Given these limitations, high-quality trials with data on long-term effects are needed.
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Affiliation(s)
- Soyoon Park
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Su-Il Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
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Gray CM, Skinner C, Vasilopoulos T, Gunaratne C, Choi J, Fadil A, Kumar S. The Kumar Technique: A Novel and Effective Approach to Transforaminal Epidural Steroid Injections. Cureus 2023; 15:e47210. [PMID: 38022188 PMCID: PMC10653120 DOI: 10.7759/cureus.47210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Transforaminal epidural steroid injections (TFESIs) are widely used as a minimally invasive treatment for lumbar radicular pain. This study presents an alternative approach for lumbar TFESI, the Kumar Technique, which utilizes a more lateral and inferior needle starting point to better align the trajectory of the needle with the neural foramen. We hypothesize the Kumar Technique will result in safer and more effective outcomes than the traditional approach to TFESI. This article was previously presented as a poster at the 2023 University of Florida College of Medicine Celebration of Research on February 27-28, 2023, and as an abstract and poster at the 2023 University of Florida Department of Anesthesiology Celebration of Research on March 29, 2023. Methods The charts for 1,424 patients who received lumbar TFESIs were retrospectively reviewed, and patients were stratified into groups receiving either the traditional approach or the Kumar Technique. Outcomes measures included numerical pain scores, measures of functional status and activity limitations, duration of pain relief, and procedural complications. Results Compared to the group undergoing the traditional approach, patients receiving the Kumar Technique reported a significantly greater decrease in average pain (-2.3 (95% CI: -3.0 to -1.6) vs -1.1 (95% CI: -1.4 to -0.7)) and maximum pain (-2.4 (95% CI: -3.2 to -1.6) vs -1.3 (95% CI: -1.8 to -0.9)). Patients receiving the Kumar Technique had a significantly greater likelihood of reporting any pain relief (OR: 2.10, 95% CI:1.59 to 2.79) compared to those undergoing the traditional approach. In addition, a greater percentage of patients receiving the Kumar Technique experienced at least one month of pain relief compared to the traditional approach (54% vs 40%; z = 3.85, p < 0.001). The occurrence of complications did not significantly vary between the modified (4.1%) and the traditional (3.0%) approaches. Conclusions The Kumar Technique is a modified TFESI approach that allows for improved access to the nerve roots through a more lateral and inferior needle entry point. The analysis supports the benefits of the Kumar Technique with patients experiencing a greater reduction in pain and longer durations of pain relief without increasing the risk of complications.
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Affiliation(s)
- Caitlin M Gray
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
- Department of Anesthesiology, North Florida/South Georgia VA, Gainesville, USA
| | - Colby Skinner
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Chamara Gunaratne
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Jin Choi
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Angela Fadil
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Sanjeev Kumar
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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Gil HY, Seo W, Choi GB, Ha E, Kim T, Ryu J, Kim JH, Choi JB. A New Role for Epidurography: A Simple Method for Assessing the Adequacy of Decompression during Percutaneous Plasma Disc Decompression. J Clin Med 2022; 11:jcm11237144. [PMID: 36498718 PMCID: PMC9741216 DOI: 10.3390/jcm11237144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an intra-procedure outcome predictor. We retrospectively enrolled 60 consecutive patients who did not respond to conventional treatments. In the next stage of treatment, PPDD was performed, and the epidurography was conducted before and after the PPDD. We analyzed the relationship between epidurographic improvement and the success rate. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure and 1 month after the procedure. The pain reduction and the success rate in the epidurographic improvement group were significantly higher than in the epidurographic non-improvement group. Both the Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups, but there was no significant difference in Oswestry Disability Index scores. This study's results showed that PPDD is an effective treatment method. We also suggested that epidurography may be a potential outcome predictor for ensuring successful outcomes and determining the endpoint of the procedure.
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Affiliation(s)
- Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Wonseok Seo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Gyu Bin Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Eunji Ha
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Taekwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Jungyul Ryu
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong 18450, Republic of Korea
| | - Jae Hyung Kim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong 18450, Republic of Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
- Correspondence: ; Tel.: +82-31-219-5571
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Alnaghmoosh N, Urquhart J, Raj R, Abraham E, Jacobs B, Phan P, Johnson M, Paquet J, Nataraj A, McIntosh G, Fisher CG, Rampersaud YR, Manson N, Hall H, Rasoulinejad P, Bailey CS. Back Dominant Pain Has Equal Outcomes to Radicular Dominant Pain Following Posterior Lumbar Fusion in Adult Isthmic Spondylolisthesis: A CSORN Study. Global Spine J 2022; 12:1667-1675. [PMID: 33406898 PMCID: PMC9609517 DOI: 10.1177/2192568220985471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES This study aimed to determine how the surgeon-determined and patient-rated location of predominant pain influences patient-rated outcomes at 1-year after posterior lumbar fusion in adult isthmic spondylolisthesis. METHODS We retrospectively reviewed consecutive patients prospectively enrolled in the Canadian Spine Outcomes and Research Network national registry between 2009 and 2017 that underwent posterior lumbar fusion for isthmic spondylolisthesis. Using longitudinal mixed-model repeated-measures analysis the change from baseline in patient-reported outcome measures (PROMs) at 1 year after surgery was compared between surgeon-determined groups (back vs. radicular) and between patient-rated pain groups (back, leg, and equal) derived from preoperative pain scores on the numerical rating scale (NRS). RESULTS 83/252 (33%) patients had a surgeon-determined chief complaint of back pain, while 103 (41%) patients rated their back pain as the predominant pain location, and 78 (31%) rated their back and leg pain to be equal. At baseline patients in the surgeon-determined radicular group had worse NRS-leg pain than those in the back-pain group but equal NRS-back pain. At baseline patients in the patient-rated equal pain group had similar back pain compared to the patient-rated back pain group and similar leg pain compared to the patient-rated leg pain group. All PROMs improved post-operatively and were not different between the 2 groups at 1 year. CONCLUSIONS Our study found no difference in outcome, irrespective of whether a surgeon determines the patient's primary pain complaint back or radicular dominant, or the patient rates pain in one location greater than another.
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Affiliation(s)
- Nabeel Alnaghmoosh
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada
| | - Jennifer Urquhart
- Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada,Jennifer Urquhart, London Health Sciences
Center, E2-619B, 800 Commissioners Road, East, London, Ontario, Canada N6A 5W9.
| | - Ruheksh Raj
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada
| | - Edward Abraham
- Department of Surgery, Canada East Spine
Centre, Saint John, New Brunswick, Canada
| | - Bradley Jacobs
- Department of Surgery, University of
Calgary, Calgary, Alberta, Canada
| | - Philippe Phan
- Department of Surgery, University of
Ottawa, Ottawa, Ontario, Canada
| | - Michael Johnson
- Departments of Orthopedics and
Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Paquet
- Department of Surgery, Laval University,
Quebec City, Quebec, Canada
| | - Andrew Nataraj
- Department of Surgery, University of
Alberta, Edmonton, Alberta, Canada
| | | | - Charles G. Fisher
- Department of Surgery, Vancouver
General Hospital/University of British Columbia, Vancouver, British Columbia,
Canada
| | | | - Neil Manson
- Department of Surgery, Canada East Spine
Centre, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- Department of Surgery, University of
Toronto, Toronto, Ontario, Canada
| | - Parham Rasoulinejad
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada,Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada,Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada
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Soar H, Comer C, Wilby M, Baranidharan G. Lumbar radicular pain. BJA Educ 2022; 22:343-349. [PMID: 36033931 PMCID: PMC9402780 DOI: 10.1016/j.bjae.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 10/16/2022] Open
Affiliation(s)
- H. Soar
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - C. Comer
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - M.J. Wilby
- Walton Centre NHS Foundation Trust, Fazackerley, Merseyside, UK
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Evidence for the BUAS-test ability to diagnose lumbar radicular pain. Br J Pain 2022; 16:23-33. [PMID: 35111311 PMCID: PMC8801693 DOI: 10.1177/20494637211005794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients' history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability. METHODS Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant (t-test) and ⩾2 points V2-V1 differences for each of the BPI-item's score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes' dependence upon independent variables. RESULTS Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes. CONCLUSION Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
- Boaz Gedaliahu Samolsky Dekel, Department of Medicine and Surgery Sciences, University of Bologna, Via Massarenti n. 9, 40138 Bologna, Italy.
| | - Maria Cristina Sorella
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Khorami AK, Oliveira CB, Maher CG, Bindels PJE, Machado GC, Pinto RZ, Koes BW, Chiarotto A. Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines. J Clin Med 2021; 10:jcm10112482. [PMID: 34205193 PMCID: PMC8200038 DOI: 10.3390/jcm10112482] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
The management of patients with lumbosacral radicular pain (LRP) is of primary importance to healthcare professionals. This study aimed to: identify international clinical practice guidelines on LRP, assess their methodological quality, and summarize their diagnostic and therapeutic recommendations. A systematic search was performed (August 2019) in MEDLINE, PEDro, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence (NICE), New Zealand Guidelines Group (NZGG), International Guideline Library, Guideline central, and Google Scholar. Guidelines presenting recommendations on diagnosis and/or treatment of adult patients with LRP were included. Two independent reviewers selected eligible guidelines, evaluated quality with Appraisal of Guidelines Research & Evaluation (AGREE) II, and extracted recommendations. Recommendations were classified into 'should do', 'could do', 'do not do', or 'uncertain'; their consistency was labelled as 'consistent', 'common', or 'inconsistent'. Twenty-three guidelines of varying quality (AGREE II overall assessment ranging from 17% to 92%) were included. Consistent recommendations regarding diagnosis are ('should do'): Straight leg raise (SLR) test, crossed SLR test, mapping pain distribution, gait assessment, congruence of signs and symptoms. Routine use of imaging is consistently not recommended. The following therapeutic options are consistently recommended ('should do'): educational care, physical activity, discectomy under specific circumstances (e.g., failure of conservative treatment). Referral to a specialist is recommended when conservative therapy fails or when steppage gait is present. These recommendations provide a clear overview of the management options in patients with LRP.
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Affiliation(s)
- Ahmad Khoshal Khorami
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.K.K.); (P.J.E.B.); (B.W.K.)
| | - Crystian B. Oliveira
- Physical Therapy Department, Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo CEP 19060-900, Brazil;
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW 2050, Australia; (C.G.M.); (G.C.M.)
| | - Christopher G. Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW 2050, Australia; (C.G.M.); (G.C.M.)
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Patrick J. E. Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.K.K.); (P.J.E.B.); (B.W.K.)
| | - Gustavo C. Machado
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW 2050, Australia; (C.G.M.); (G.C.M.)
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Rafael Z. Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30000-000, Brazil;
| | - Bart W. Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.K.K.); (P.J.E.B.); (B.W.K.)
- Center for Muscle and Joint Health, University of Southern Denmark, 5230 Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.K.K.); (P.J.E.B.); (B.W.K.)
- Correspondence: ; Tel.: +31-1-0704-1038
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Gil HY, Jeong S, Cho H, Choi E, Nahm FS, Lee PB. Kambin's Triangle Approach versus Traditional Safe Triangle Approach for Percutaneous Transforaminal Epidural Adhesiolysis Using an Inflatable Balloon Catheter: A Pilot Study. J Clin Med 2019; 8:jcm8111996. [PMID: 31731783 PMCID: PMC6912526 DOI: 10.3390/jcm8111996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/25/2022] Open
Abstract
Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter can reduce the patients’ pain and improve their functional capacity. We aimed to evaluate the safety and efficacy of the Kambin’s-triangle approach for PTFA using an inflatable balloon catheter and compare this approach to the traditional safe-triangle approach. Thirty patients with chronic unilateral L5 radiculopathy were divided into two groups: the safe-triangle-approach and Kambin’s-triangle-approach groups, with 15 patients each. The success rate of the procedure was assessed. Pain and dysfunction were assessed using the Numerical Rating Scale and Oswestry Disability Index, respectively, before the procedure and at 1 and 3 months after the procedure. The success rate of the procedure was high in both the groups, with no significant difference between the groups. The Numerical Rating Scale and Oswestry Disability Index scores significantly decreased 3 months after the procedure in both the groups, with no significant difference between the groups. For patients in whom the safe-triangle approach for PTFA is difficult, the Kambin’s-triangle approach could be an alternative.
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Affiliation(s)
- Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Ajou University College of Medicine, Suwon 16499, Korea;
| | - Sangmin Jeong
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Hyunwook Cho
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
- Correspondence: ; Tel.: +82-31-787-7499
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Oh Y, Kim DH, Park JY, Ji GY, Shin DA, Lee SW, Park JK, Shin JW, Choi SS. Factors Associated with Successful Response to Balloon Decompressive Adhesiolysis Neuroplasty in Patients with Chronic Lumbar Foraminal Stenosis. J Clin Med 2019; 8:E1766. [PMID: 31652838 DOI: 10.3390/jcm8111766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from epidural steroid injection or even epidural neuroplasty with a balloon-less catheter. However, exact indications or predictive factors for epidural balloon neuroplasty have not been fully evaluated. Therefore, to assess associated factors that could affect a favorable outcome, we analyzed a prospectively collected multicenter cohort of patients with chronic refractory lumbar foraminal stenosis after balloon neuroplasty. At the 6-month point in follow-up, 92 (44.4%) patients among 207 subjects were classified as successful responders according to a robust combination of outcome measures. Multivariate logistic regression analysis also showed that mild grade lumbar foraminal stenosis may be an independent factor associated with a successful response 6 months after balloon neuroplasty (odds ratio = 2.829; 95% confidence interval = 1.351–5.923; p = 0.006). However, we found that there were 29.4% and 24.6% successful responders with moderate and severe foraminal stenosis, respectively. Attempting balloon neuroplasty in refractory lumbar foraminal stenosis, especially mild grade, may be worthwhile.
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Park JY, Ji GY, Lee SW, Park JK, Ha D, Park Y, Cho SS, Moon SH, Shin JW, Kim DJ, Shin DA, Choi SS. Relationship of Success Rate for Balloon Adhesiolysis with Clinical Outcomes in Chronic Intractable Lumbar Radicular Pain: A Multicenter Prospective Study. J Clin Med 2019; 8:jcm8050606. [PMID: 31058860 PMCID: PMC6572522 DOI: 10.3390/jcm8050606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/28/2019] [Indexed: 12/29/2022] Open
Abstract
Combined balloon decompression and epidural adhesiolysis has been reported to be effective in refractory lumbar spinal stenosis. Many cases of intractable stenosis have symptom-related multiple target sites for interventional treatment. In this situation it may not be possible to perform balloon adhesiolysis, or even only epidural adhesiolysis, for all target sites. Therefore, this multicenter prospective observational study aimed to evaluate the relationship of successful ballooning rate for multiple target sites with clinical outcome. Based on the ballooning success rate of multiple target sites, the patients were divided into three groups: below 50%, 50–85%, and above 85% ballooning. A greater ballooning success rate for multiple target sites provided a more decreased pain intensity and improved functional status in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 6 months. The estimated proportions of successful responders according to a multidimensional approach in the below 50%, 50–85%, and above 85% balloon success groups at 6 months after the procedure were 0.292, 0.468, and 0.507, respectively (p = 0.038). Our study suggests the more successful balloon adhesiolysis procedures for multiple target lesions are performed, the better clinical outcome can be expected at least 6 months after treatment.
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Affiliation(s)
- Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Gyu Yeul Ji
- Department of Neurosurgery, Spine and Joint Research Institute, Guro Cham Teun Teun Hospital, Seoul 08392, Korea.
| | - Sang Won Lee
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Jin Kyu Park
- Department of Neurosurgery, Himchan Hospital, Bupyeong 21399, Korea.
| | - Dongwon Ha
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Youngmok Park
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan 49201, Korea.
| | - Sang Ho Moon
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul 02488, Korea.
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
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Abstract
This review provides an overview of the diagnosis and treatment strategies for the management of radicular pain. While it is not as common as axial spinal pain, radicular pain combines the advantage of leveraging appropriate diagnostic strategies and definitive treatments with well-informed outcome measures. Multiple diagnostic measures include not only history and physical examination, but also imaging. The treatment modalities include pharmacologic management, physical and rehabilitation measures, interventional techniques and surgical treatments. Here, the authors describe the prevalence and pathophysiology of radicular pain, risk factors, diagnostic strategies, treatment modalities and the evidence for these management strategies. Finally, the authors show the efficacy of conservative management, despite surgical management being the gold standard.
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