Yonsei Med J.  2015 May;56(3):691-697. 10.3349/ymj.2015.56.3.691.

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

• Ji GY
• Oh CH
• Moon B
• Choi SH
• Shin DA
• Yoon YS
• Kim KN

• KMID: 2450342
• DOI: http://doi.org/10.3349/ymj.2015.56.3.691

Abstract

PURPOSE
Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease.
MATERIALS AND METHODS
This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment.
RESULTS
The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material.
CONCLUSION
PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.

Keyword

Lower back pain; lumbar disc disease; percutaneous epidural neuroplasty; percutaneous adhesiolysis; dural sac cross-sectional area

MeSH Terms

Adult
Aged
Back Pain/etiology/*surgery
Dura Mater/*pathology
Female
Humans
Intervertebral Disc
Intervertebral Disc Displacement
Magnetic Resonance Imaging
Male
Middle Aged
Reconstructive Surgical Procedures
Spinal Stenosis/complications/*pathology
Tissue Adhesions/*surgery
Treatment Outcome
Visual Analog Scale

Figure

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  Fig. 1 Image of a typical dural sac cross-sectional area, showing the total spinal canal area (white dashed line), canal area compromised by disc material (gray dashed line), and neural structures (dark gray dashed line).

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  Fig. 2 Epidurography pattern of percutaneous epidural neuroplasty at the level of L4/5.

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  Fig. 3 Flowchart of patient stratification and follow-up after percutaneous epidural neuroplasty (PEN) due to lumbar disc herniation (LDH).

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  Fig. 4 Comparison of VAS scores according to the degree of spinal canal compromise (less or more than 50%) at 0, 1, 3, 6, 12, and 24 months after treatment. No statistically significant differences (p<0.05) were observed between the groups during the follow-up periods. VAS, Visual Analog Scale.

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  Fig. 5 Comparison of VAS scores according to the degree of spinal canal compromise (less than 33.3%, between 33.3 to 66.7%, and more than 66.7%) at 0, 1, 3, 6, 12, and 24 months after treatment. No statistically significant differences (p<0.05) were observed between the groups during the follow-up periods. VAS, Visual Analog Scale.

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