Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

Sang Ho Moon, Jae Il Lee, Hyun Seok Cho, Jin Woo Shin, Won Uk Koh, Sang Ho Moon, Jae Il Lee, Hyun Seok Cho, Jin Woo Shin, Won Uk Koh

Abstract

Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ) at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P = 0.007). The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P = 0.02). Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.

Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this article.

Figures

Figure 1
Figure 1
Fluoroscopic image of a patient receiving a percutaneous epidural adhesiolysis. Anteroposterior view (a) and lateral view (b).
Figure 2
Figure 2
A T2-weighted magnetic resonance image showing the high-intensity zone (arrow) in a patient with a L4-5 herniated lumbar intervertebral disc. Sagittal view (a) and axial view (b).
Figure 3
Figure 3
Change in numerical rating scale (NRS) pain scores between the substantial responder and nonresponder groups during follow-up; ∗P = 0.007, †P < 0.001.
Figure 4
Figure 4
The proportion of substantial responders in the high-intensity zone (HIZ) positive patients and the HIZ negative patients; ∗P = 0.028, †P = 0.002.

References

    1. Borkan J., Van Tulder M., Reis S., Schoene M. L., Croft P., Hermoni D. Advances in the field of low back pain in primary care: a report from the fourth international forum. Spine. 2002;27(5):E128–E132. doi: 10.1097/00007632-200203010-00019.
    1. Hoy D., Brooks P., Blyth F., Buchbinder R. The epidemiology of low back pain. Best Practice and Research: Clinical Rheumatology. 2010;24(6):769–781. doi: 10.1016/j.berh.2010.10.002.
    1. Rhee J. M., Schaufele M., Abdu W. A. Radiculopathy and the herniated lumbar disc. Controversies regarding pathophysiology and management. The Journal of Bone and Joint Surgery. 2006;88(9):2070–2080.
    1. Ghahreman A., Ferch R., Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Medicine. 2010;11(8):1149–1168. doi: 10.1111/j.1526-4637.2010.00908.x.
    1. Tosteson A. N. A., Tosteson T. D., Lurie J. D., et al. Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine. 2011;36(24):2061–2068. doi: 10.1097/brs.0b013e318235457b.
    1. Weber H. The natural history of disc herniation and the influence of intervention. Spine (Phila Pa 1976) 1994;19:2234–2238.
    1. Koes B. W., van Tulder M. W., Peul W. C. Diagnosis and treatment of sciatica. British Medical Journal. 2007;334(7607):1313–1317. doi: 10.1136/.
    1. Rados I., Sakic K., Fingler M., Kapural L. Efficacy of interlaminar vs transforaminal epidural steroid injection for the treatment of chronic unilateral radicular pain: prospective, randomized study. Pain Medicine. 2011;12(9):1316–1321. doi: 10.1111/j.1526-4637.2011.01213.x.
    1. Gerdesmeyer L., Wagenpfeil S., Birkenmaier C., et al. Percutaneous epidural lysis of adhesions in chronic lumbar radicular pain: a randomized, double-blind, placebo-controlled trial. Pain Physician. 2013;16(3):185–196.
    1. Lee J. H., Lee S.-H. Clinical effectiveness of percutaneous adhesiolysis using navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician. 2012;15(3):213–221.
    1. Peul W. C., Van Houwelingen H. C., Van Den Hout W. B., et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007;356(22):2245–2256. doi: 10.1056/NEJMoa064039.
    1. Andersson G. B. J., Brown M. O., Dvorak J., et al. Consensus summary on the diagnosis and treatment of lumbar disc herniation. Spine. 1996;21(24):75S–78S.
    1. Lequin M. B., Verbaan D., Jacobs W. C. H., et al. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013;3(5) doi: 10.1136/bmjopen-2012-002534.e002534
    1. Lee F., Jamison D. E., Hurley R. W., Cohen S. P. Epidural lysis of adhesions. Korean Journal of Pain. 2014;27(1):3–15. doi: 10.3344/kjp.2014.27.1.3.
    1. Manchikanti L., Helm S., Pampati V., Racz G. B. Percutaneous adhesiolysis procedures in the medicare population: analysis of utilization and growth patterns from 2000 to 2011. Pain Physician. 2014;17(2):E129–E139.
    1. Choi E., Nahm F. S., Lee P.-B. Evaluation of prognostic predictors of percutaneous adhesiolysis using a racz catheter for post lumbar surgery syndrome or spinal stenosis. Pain Physician. 2013;16(5):E531–E536.
    1. Lee J. H., Lee S.-H. Clinical effectiveness of percutaneous adhesiolysis and predictive factors of treatment efficacy in patients with lumbosacral spinal stenosis. Pain Medicine. 2013;14(10):1497–1504. doi: 10.1111/pme.12180.
    1. Manchikanti L., Abdi S., Atluri S., et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(2):S49–S283.
    1. Racz G. B., Heavner J. E., Trescot A. Percutaneous lysis of epidural adhesions—evidence for safety and efficacy. Pain Practice. 2008;8(4):277–286. doi: 10.1111/j.1533-2500.2008.00203.x.
    1. Jensen M. C., Brant-Zawadzki M. N., Obuchowski N., Modic M. T., Malkasian D., Ross J. S. Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine. 1994;331(2):69–73. doi: 10.1056/NEJM199407143310201.
    1. Wiltse L. L., Berger P. E., McCulloch J. A. A system for reporting the size and location of lesions in the spine. Spine. 1997;22(13):1534–1537. doi: 10.1097/00007632-199707010-00023.
    1. Mysliwiec L. W., Cholewicki J., Winkelpleck M. D., Eis G. P. MSU Classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection. European Spine Journal. 2010;19(7):1087–1093. doi: 10.1007/s00586-009-1274-4.
    1. Farrar J. T., Young J. P., Jr., LaMoreaux L., Werth J. L., Poole R. M. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–158. doi: 10.1016/S0304-3959(01)00349-9.
    1. Dworkin R. H., Turk D. C., Wyrwich K. W., et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain. 2008;9:105–121.
    1. Kelsey J. L., White III A. A., Sci M. Epidemiology and impact of low-back pain. Spine. 1980;5(2):133–142. doi: 10.1097/00007632-198003000-00007.
    1. Hakelius A. Prognosis in sciatica. A clinical follow-up of surgical and non-surgical treatment. Acta Orthopaedica Scandinavica, Supplement. 1970;129:1–76.
    1. Vroomen P. C. A. J., de Krom M. C. T. F. M., Slofstra P. D., Knottnerus J. A. Conservative treatment of sciatica: a systematic review. Journal of Spinal Disorders. 2000;13(6):463–469. doi: 10.1097/00002517-200012000-00001.
    1. Radcliff K., Hilibrand A., Lurie J. D., et al. The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial. Journal of Bone and Joint Surgery A. 2012;94(15):1353–1358. doi: 10.2106/jbjs.k.00341.
    1. Arden N. K., Price C., Reading I., et al. A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology. 2005;44(11):1399–1406. doi: 10.1093/rheumatology/kei028.
    1. Manson N. A., McKeon M. D., Abraham E. P. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series. Canadian Journal of Surgery. 2013;56(2):89–96. doi: 10.1503/cjs.014611.
    1. Buttermann G. R. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy: A Prospective, Randomized Study. Journal of Bone and Joint Surgery—Series A. 2004;86(4):670–679. doi: 10.2106/00004623-200404000-00002.
    1. Manchikanti L., Cash K. A., Pampati V., Falco F. J. E. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician. 2014;17(4):E489–E501.
    1. Manchikanti L., Singh V., Cash K. A., Pampati V., Damron K. S., Boswell M. V. A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis. Spine. 2011;36(23):1897–1905. doi: 10.1097/BRS.0b013e31823294f2.
    1. Taskaynatan M. A., Tezel K., Yavuz F., Tan A. K. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment. Journal of Back and Musculoskeletal Rehabilitation. 2015;28(3):447–451. doi: 10.3233/bmr-140539.
    1. Aprill C., Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. British Journal of Radiology. 1992;65(773):361–369. doi: 10.1259/0007-1285-65-773-361.
    1. Khan I., Hargunani R., Saifuddin A. The lumbar high-intensity zone: 20 years on. Clinical Radiology. 2014;69(6):551–558. doi: 10.1016/j.crad.2013.12.012.
    1. Lam K. S., Carlin D., Mulholland R. C. Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source. European Spine Journal. 2000;9(1):36–41. doi: 10.1007/s005860050006.
    1. Chen J.-Y., Ding Y., Lv R.-Y., et al. Correlation between MR imaging and discography with provocative concordant pain in patients with low back pain. Clinical Journal of Pain. 2011;27(2):125–130. doi: 10.1097/AJP.0b013e3181fb2203.
    1. Saifuddin A., Braithwaite I., White J., Taylor B. A., Renton P. The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears. Spine. 1998;23(4):453–457. doi: 10.1097/00007632-199802150-00009.
    1. Liu C., Cai H.-X., Zhang J.-F., Ma J.-J., Lu Y.-J., Fan S.-W. Quantitative estimation of the high-intensity zone in the lumbar spine: comparison between the symptomatic and asymptomatic population. Spine Journal. 2014;14(3):391–396. doi: 10.1016/j.spinee.2013.06.078.
    1. Wang Z.-X., Hu Y.-G. High-intensity zone (HIZ) of lumbar intervertebral disc on T2-weighted magnetic resonance images: spatial distribution, and correlation of distribution with low back pain (LBP) European Spine Journal. 2012;21(7):1311–1315. doi: 10.1007/s00586-012-2240-0.
    1. Carragee E. J., Paragioudakis S. J., Khurana S. 2000 Volvo Award winner in clinical studies: Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976) 2000;25(23):2987–2992.
    1. Stadnik T. W., Lee R. R., Coen H. L., Neirynck E. C., Buisseret T. S., Osteaux M. J. C. Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology. 1998;206(1):49–55. doi: 10.1148/radiology.206.1.9423651.
    1. Dongfeng R., Hou S., Wu W., et al. The expression of tumor necrosis factor-α and CD68 in high-intensity zone of lumbar intervertebral disc on magnetic resonance image in the patients with low back pain. Spine. 2011;36(6):E429–E433. doi: 10.1097/BRS.0b013e3181dfce9e.
    1. Peng B., Hou S., Wu W., Zhang C., Yang Y. The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain. European Spine Journal. 2006;15(5):583–587. doi: 10.1007/s00586-005-0892-8.
    1. Heavner J. E., Racz G. B., Raj P. Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase. Regional Anesthesia and Pain Medicine. 1999;24(3):202–207.
    1. Koh W. U., Choi S. S., Park S. Y., et al. Transforaminal hypertonic saline for the treatment of lumbar lateral canal stenosis: a double-blinded, randomized, active-control trial. Pain Physician. 2013;16(3):197–211.
    1. King J. S., Jewett D. L., Sundberg H. R. Differential blockade of cat dorsal root C fibers by various chloride solutions. Journal of Neurosurgery. 1972;36(5):569–583. doi: 10.3171/jns.1972.36.5.0569.
    1. Matsuka Y., Spigelman I. Hyperosmolar solutions selectively block action potentials in rat myelinated sensory fibers: implications for diabetic neuropathy. Journal of Neurophysiology. 2004;91(1):48–56. doi: 10.1152/jn.00689.2003.
    1. Cha S. O., Jang C. H., Hong J. O., Park J. S., Park J. H. Use of magnetic resonance imaging to identify outcome predictors of caudal epidural steroid injections for lower lumbar radicular pain caused by a herniated disc. Annals of Rehabilitation Medicine. 2014;38(6):791–798. doi: 10.5535/arm.2014.38.6.791.
    1. Choi S. S., Joo E. Y., Hwang B. S., et al. A novel balloon-inflatable catheter for percutaneous epidural adhesiolysis and decompression. Korean Journal of Pain. 2014;27(2):178–185. doi: 10.3344/kjp.2014.27.2.178.
    1. Turk D. C., Dworkin R. H., Allen R. R., et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337–345. doi: 10.1016/j.pain.2003.08.001.
    1. Al Nezari N. H., Schneiders A. G., Hendrick P. A. Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis. Spine Journal. 2013;13(6):657–674. doi: 10.1016/j.spinee.2013.02.007.

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