Clinical Effectiveness of Percutaneous Adhesiolysis Using Navicath for the Management of Chronic Pain Due to Lumbosacral Disc Herniation

Wooridul Spine Hospital, Seoul, Korea.
Pain physician (Impact Factor: 3.54). 05/2012; 15(3):213-21.
Source: PubMed


Epidural steroid injection has been frequently performed to treat chronic pain due to lumbosacral disc herniation (L-HIVD). However, a considerable number of patients do not achieve pain relief using this method because perineural or epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) is thought to be a useful method because it can eliminate the deleterious effects of adhesion.
This study aimed to evaluate the effectiveness of PA in managing chronic pain due to L-HIVD and the clinical and radiological predictive factors for the effectiveness of PA using NaviCath®.
Retrospective study
Spine hospital
From a group of patients diagnosed with L-HIVD, we selected the 86 patients who underwent PA with NaviCath® who had experienced chronic lower back or leg pain for at least 3 months and had failed to respond to anti-inflammatory medications or physical therapy of at least 1 month's duration and fluoroscopy guided transforaminal epidural injection. We recorded the Numeric Rating Scale for back pain (NRS back) and leg pain (NRS leg) and the Oswestry Disability Index (ODI) at pretreatment, 2 weeks, and 3 months after treatment. Clinical data and magnetic resonance imaging (MRI) findings were obtained to assess the possible predictive factors for PA efficacy.
Retrospective chart review without a control group.
At 2 weeks after PA, significant improvement was observed in NRS back, NRS leg, and ODI compared with pretreatment. This improvement was maintained until 3 months after treatment. Among 86 patients, 61 (70.9%), 53 (61.6%) and 61 patients (70.9%) showed successful outcomes in NRS back, NRS leg, and ODI at 2 weeks, respectively. Among 74 patients who were followed up at 3 months, 47 (63.5%), 44 patients (59.5%), and 50 patients (67.6%) showed successful results in NRS back, NRS leg, and ODI at 3 months, respectively. A significantly higher proportion of patients with a history of previous lumbar surgery showed unsuccessful results on NRS back, NRS leg, and ODI scores at 2 weeks and 3 months. Co-existence of spinal stenosis was associated with a significantly higher proportion of unsuccessful results in NRS back and ODI at 2 weeks and 3 months, as well as NRS leg at 3 months. Patients with spondylolisthesis also showed a significantly higher proportion of unsuccessful results in NRS and ODI at 2 weeks.
PA with NaviCath® showed clinical effectiveness in the treatment of chronic pain due to L-HIVD that was not responsive to transforaminal epidural injection. Previous surgery and the presence of spinal stenosis or spondylolisthesis were poor prognostic predictors. This procedure may enable the physician to place the catheter tip and deliver medicine more precisely.

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    • "The PA group showed significantly better therapeutic outcomes as measured by VNS and ODI at the 3-month follow-up. In two retrospective studies evaluating the effectiveness of PA, poor outcomes were more common in patients with foraminal stenosis[26,27]. Poor outcomes were attributable to the association of LSS with irreversible changes such as epidural scars and hypertrophy of bony structures and ligaments; such changes may render the nerve root refractory to management by the local application of corticosteroids[28,29]. "
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    ABSTRACT: Objective: To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods: This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results: ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion: Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.
    Full-text · Article · Jan 2015 · Annals of Rehabilitation Medicine
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    • "In order to control the direction of the catheter during the procedure, other instruments have been developed. Among them, the NaviCath, which is more steerable and can be bent to only one side, has been reported to be clinically effective in the treatment of chronic lower back pain that is not responsive to transforaminal epidural injection [9]. However, this procedure has some limitations in patients with a severe degree of adhesion or severe spinal stenosis because of the difficulty in placing the catheter at the target area. "
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    ABSTRACT: Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis.
    Full-text · Article · Apr 2014 · The Korean journal of pain
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    • "No benefit was noted for either the use of a reinforced navigable catheter or the addition of hyaluronidase. In two retrospective studies evaluating the effectiveness of percutaneous adhesiolysis by Lee et al., a poor outcome was more common in patients with previous surgery, spondylolisthesis, herniated disc, and lumbosacral and foraminal stenosis [64,65]. An observational study by Park et al. performed in 66 patients with clinical spinal stenosis found no association between LOA outcome and the anatomical degree of stenosis [45]. "
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    ABSTRACT: As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.
    Full-text · Article · Jan 2014 · The Korean journal of pain
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