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Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle.

Ahn K, Jhun HJ, Lim TK, Lee YS - BMC Musculoskelet Disord (2010)

Bottom Line: The procedure was completed when a marked reduction in resistance was felt at the tip of the needle.The visual analogue scale (VAS) pain score was reduced from 7.3 +/- 2.0 to 4.6 +/- 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 +/- 17.2 to 25.5 +/- 12.6% and the average self-rated improvement was 52.6 +/- 33.1%.The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chronic Pain Management Centre, Cha Biomedical Centre, Kangnam Cha Hospital, Cha University, 605 Yeoksam-Dong, Kangnam-Ku, Seoul, Republic of Korea.

ABSTRACT

Background: This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS).

Methods: Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis.

Results: The average follow-up period was 12.9 +/- 1.1 months. The visual analogue scale (VAS) pain score was reduced from 7.3 +/- 2.0 to 4.6 +/- 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 +/- 17.2 to 25.5 +/- 12.6% and the average self-rated improvement was 52.6 +/- 33.1%. The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale.

Conclusions: These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS.

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Three-dimensional CT images of the transforaminal epidural dry needling procedure. The sagittal CT image shows the area where the transforaminal epidural dry needling was performed (A). The coronal (B) and axial (C) CT images show the depth and route of needle insertion.
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Figure 1: Three-dimensional CT images of the transforaminal epidural dry needling procedure. The sagittal CT image shows the area where the transforaminal epidural dry needling was performed (A). The coronal (B) and axial (C) CT images show the depth and route of needle insertion.

Mentions: Many studies have demonstrated the anatomy of the lumbar spine [10] and the pathophysiological mechanisms of LSS [11-13]. Based on these studies, we postulated that the posterior epidural space adjacent to the intervertebral foramen that lies between the anterior side of the facet joint and pedicle in the sagittal plane (Figure 1A), usually up to the outer-third of the pedicle in the coronal plane (Figure 1B) and between the ligamentum flavum and the dural sleeve in the axial plane (Figure 1C) should be the primary treatment target in LSS. However, additional treatment was performed in the anterior epidural space if the posterior epidural approach did not produce a favourable treatment outcome.


Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle.

Ahn K, Jhun HJ, Lim TK, Lee YS - BMC Musculoskelet Disord (2010)

Three-dimensional CT images of the transforaminal epidural dry needling procedure. The sagittal CT image shows the area where the transforaminal epidural dry needling was performed (A). The coronal (B) and axial (C) CT images show the depth and route of needle insertion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2927508&req=5

Figure 1: Three-dimensional CT images of the transforaminal epidural dry needling procedure. The sagittal CT image shows the area where the transforaminal epidural dry needling was performed (A). The coronal (B) and axial (C) CT images show the depth and route of needle insertion.
Mentions: Many studies have demonstrated the anatomy of the lumbar spine [10] and the pathophysiological mechanisms of LSS [11-13]. Based on these studies, we postulated that the posterior epidural space adjacent to the intervertebral foramen that lies between the anterior side of the facet joint and pedicle in the sagittal plane (Figure 1A), usually up to the outer-third of the pedicle in the coronal plane (Figure 1B) and between the ligamentum flavum and the dural sleeve in the axial plane (Figure 1C) should be the primary treatment target in LSS. However, additional treatment was performed in the anterior epidural space if the posterior epidural approach did not produce a favourable treatment outcome.

Bottom Line: The procedure was completed when a marked reduction in resistance was felt at the tip of the needle.The visual analogue scale (VAS) pain score was reduced from 7.3 +/- 2.0 to 4.6 +/- 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 +/- 17.2 to 25.5 +/- 12.6% and the average self-rated improvement was 52.6 +/- 33.1%.The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chronic Pain Management Centre, Cha Biomedical Centre, Kangnam Cha Hospital, Cha University, 605 Yeoksam-Dong, Kangnam-Ku, Seoul, Republic of Korea.

ABSTRACT

Background: This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS).

Methods: Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis.

Results: The average follow-up period was 12.9 +/- 1.1 months. The visual analogue scale (VAS) pain score was reduced from 7.3 +/- 2.0 to 4.6 +/- 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 +/- 17.2 to 25.5 +/- 12.6% and the average self-rated improvement was 52.6 +/- 33.1%. The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale.

Conclusions: These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS.

Show MeSH
Related in: MedlinePlus