- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06051149
Effect of Catheter Type on Efficacy of Percutaneous Caudal Adhesolysis
Effect of Catheter Type on Efficacy of Percutaneous Caudal Adhesolysis in Failed Back Surgery Syndrome.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The international association for the study of pain has defined failed back syndrome as persistent pain despite spine surgery in the same topographical area.
Several causes have been introduced for FBSS including pressure on the nerve root due to disc re-herniation or retained disc fragment, epidural fibrosis, acquired stenosis, and segmental instability.
Thus, FBSS is a syndrome with diverse etiologies and noticeable heterogeneity among patients. However, about 20% to 36% of FBSS occur due to epidural fibrosis, which is a progressive disease.
The approach toward FBSS involves conservative management that consists of physical therapy and medication which aims to optimize gait and posture and can improve muscle strength and physical function. Oral pharmacological treatment of FBSS is multimodal and increasingly controversial. Treatments include antiepileptics, non-steroidal anti-inflammatory drugs, oral steroids, antidepressants, and opioids including injections, and finally surgical options as a last line therapy. Other modalities including minimally invasive procedures like epidural injections, Epidural steroid injections (ESIs) are the most commonly performed procedure in pain clinics around the world. These can be administered primarily by three approaches: transforaminal, interlaminar, or caudally, and are indicated for symptoms of radiculopathy. Also radiofrequency ablation of nerves are often used to provide sustained relief that a diagnostic block or therapeutic injection cannot provide. Successfully targeting the intended nerve is achieved, maximizing the size of the lesion. Spinal cord stimulation (SCS) is a nother treatment modality that has shown tremendous potential in the management of FBSS. Adhesions can theoretically be lysed, thereby improving baseline pain scores and drug delivery of the ESI. Lysis of adhesions typically occurs by delivering hyaluronidase with hypertonic saline into the epidural space. The use of hyaluronidase with steroid may be more effective and have longer duration of effect than either one alone. Finally, surgical revision for FBSS is associated with a high morbidity with corresponding low rates of success.
Percutaneous adhesiolysis (PA), is a minimally invasive technique, that might be useful in the treatment of chronic pain refractory to conservative treatments. The basic idea behind PA is inserting a catheter in the ventral epidural space could directly break up perineural/epidural adhesions, that act as physical barriers to the perineurally deposited drugs but also cause neural irritation predisposing to neural inflammation.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- previous back surgery of at least 6 months duration.
- age ≥ 18.
- failure of conventional pharmacological management.
Exclusion Criteria:
- cauda equina syndrome.
- pregnant or lactating women.
- anti-coagulant therapy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Epidural Catheter
procedure Will be performed under sterile precautions utilizing fluoroscopy, RK needle.patient
will be placed prone with a pillow under the abdomen.The sacral area draped from the top of the iliac crest to the bottom of the buttocks.The sacral Corns and the sacral hiatus will be palpated,is in the gluteal fold opposite the affected side will be infiltrated with lidocaine16gauge RK needle will be passed through the described entry point advanced to a point below the S3foramen to prevent S3nerve root damage.Placement will be confirmed by lateral and anteroposterior fluoroscopic views and after aspiration is negative for blood and CSF10mL of iohexol will be injected under fluoroscopy.Once the needle placement is confirmed to be in the epidural space, a lumbar epidurogram will be carried out utilizing approximately2to5 mL of contrast.
then the bevel of the needle should face the ventrolateral aspect of the caudal canal.
|
caudal adhesolysis for patients with failed back surgery syndrome using RACZ Catheter under fluroscopy
caudal adhesolysis for patients with failed back surgery syndrome using NAVI Catheter under fluroscopy
|
Active Comparator: RACZ Catheter
same as procedure described above but using RACZ Catheter set
|
caudal adhesolysis for patients with failed back surgery syndrome using RACZ Catheter under fluroscopy
|
Active Comparator: NAVI catheter
same as procedure described above but using NAVI Catheter set
|
caudal adhesolysis for patients with failed back surgery syndrome using NAVI Catheter under fluroscopy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain score
Time Frame: 6 months after intervention
|
-difference in numeric rating scale at 6 months after intervention, minmal value 0 and maximum value 100 which is worst(more pain intensity)
|
6 months after intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
functional outcome
Time Frame: 6 months after intervention
|
The Oswestry Disability Index,minmal value 0 and maximum value 50 which is worst(complete disability)
|
6 months after intervention
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- AUN1615
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Failed Back Surgery Syndrome
-
University of Sao PauloCompletedLow Back Pain | Failed Back Surgery SyndromeBrazil
-
Fundación Universidad Católica de Valencia San...Instituto de Investigación Biomédica de SalamancaNot yet recruitingFailed Back Surgery SyndromeSpain
-
Poitiers University HospitalCompleted
-
Boston Scientific CorporationTerminatedPain | Back Pain | Failed Back Surgery SyndromeUnited States, United Kingdom, Canada, France
-
Moens MaartenCompleted
-
Jaseng Hospital of Korean MedicineCompletedFailed Back Surgery SyndromeKorea, Republic of
-
MedtronicNeuroTerminatedFailed Back Surgery SyndromeFrance, Germany, Belgium, Austria, Netherlands, Australia, Switzerland, United Kingdom, Spain, Israel
-
Poitiers University HospitalCompleted
-
Sahlgrenska University Hospital, SwedenRecruitingFailed Back Surgery SyndromeSweden, Denmark, Netherlands, Belgium
Clinical Trials on caudal adhesolysis using RACZ Catheter
-
Assiut UniversityCompleted
-
Europainclinics z.ú.Brno University Hospital; Pavol Jozef Safarik University; Slovak Academy of SciencesCompleted
-
Asan Medical CenterActive, not recruitingSarcopenia | Lumbar Spinal Stenosis | Neurogenic ClaudicationKorea, Republic of
-
Charles University, Czech RepublicRecruitingAtrial FibrillationCzechia
-
StereotaxisTerminatedTachycardia, VentricularUnited States, Netherlands, Australia, Belgium, Denmark, France, Czechia
-
Herz-Zentrums Bad KrozingenBoston Scientific Corporation; CryoCath Technologies Inc.UnknownAtrial Fibrillation AblationGermany
-
Clinica MediterraneaCompletedAtrial FibrillationItaly
-
Nanfang Hospital of Southern Medical UniversityFujian Cancer Hospital; Fujian Provincial HospitalUnknown
-
Ajou University School of MedicineCompletedIntubation;DifficultKorea, Republic of
-
University of Erlangen-Nürnberg Medical SchoolCompleted