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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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Related in: MedlinePlus

The needle used in fluoroscopically guided transforaminal epidural dry needling to treat lumbar spinal stenosis. The Round Needle before bending (A) and close-ups of its tip from above (B) and the side (C). The flexed Round Needle after bending (D) and close-ups of its tip from above (E) and the side (F).
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Figure 2: The needle used in fluoroscopically guided transforaminal epidural dry needling to treat lumbar spinal stenosis. The Round Needle before bending (A) and close-ups of its tip from above (B) and the side (C). The flexed Round Needle after bending (D) and close-ups of its tip from above (E) and the side (F).

Mentions: We treated LSS using a specially designed needle (Round Needle® Hansung Precision, Korea) that is 1.2 mm in diameter and 120 mm long (Figure 2A). The needle is streamlined, solid and flexible, and has a blunt, round tip [14] (Figures 2B and 2C). We bent the needle 5-30° at a point 2-4 mm from the tip (Figures 2D, E and 2F) using surgical tweezers to allow it to accurately reach the target structures and avoid damage to the spine, particularly possible damage to arteries because of anatomical variation or neovascularisation of the lesion [15]. The degree of bending was determined after identifying the shape of the intervertebral foramen on the axial CT image.


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)

The needle used in fluoroscopically guided transforaminal epidural dry needling to treat lumbar spinal stenosis. The Round Needle before bending (A) and close-ups of its tip from above (B) and the side (C). The flexed Round Needle after bending (D) and close-ups of its tip from above (E) and the side (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: The needle used in fluoroscopically guided transforaminal epidural dry needling to treat lumbar spinal stenosis. The Round Needle before bending (A) and close-ups of its tip from above (B) and the side (C). The flexed Round Needle after bending (D) and close-ups of its tip from above (E) and the side (F).
Mentions: We treated LSS using a specially designed needle (Round Needle® Hansung Precision, Korea) that is 1.2 mm in diameter and 120 mm long (Figure 2A). The needle is streamlined, solid and flexible, and has a blunt, round tip [14] (Figures 2B and 2C). We bent the needle 5-30° at a point 2-4 mm from the tip (Figures 2D, E and 2F) using surgical tweezers to allow it to accurately reach the target structures and avoid damage to the spine, particularly possible damage to arteries because of anatomical variation or neovascularisation of the lesion [15]. The degree of bending was determined after identifying the shape of the intervertebral foramen on the axial CT image.

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