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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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Fluoroscopy images of the transforaminal epidural dry needling procedure. The anteroposterior (A) and lateral (B) fluoroscopy images are from a patient undergoing the intervention.
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Figure 3: Fluoroscopy images of the transforaminal epidural dry needling procedure. The anteroposterior (A) and lateral (B) fluoroscopy images are from a patient undergoing the intervention.

Mentions: At the level of the stenosis, the flexed Round Needle was inserted 8-12 cm lateral to the midline with the concave surface facing up. The needle was advanced at a 15-30° angle to the horizontal plane until the flexed tip contacted the lumbar spine (Figure 3A). Then the C-arm was turned to the lateral view. The tip of the needle was positioned between the anterior side of the facet joint and pedicle (Figure 3B), and was then advanced to the outer-third of the pedicle (Figure 1B). It was advanced further, to the inner line of pedicle, as an additional treatment for the anterior epidural space if the previous posterior epidural approach did not produce a favourable treatment outcome. The needle was advanced medially and backed laterally a few millimetres along the canal side of the inferior articular process between the anterior side of the facet joint and pedicle. The procedure was complete when we felt a marked reduction in resistance at the tip of the needle. The procedure was performed bilaterally at each level of the stenosis (Additional file 1: A movie demonstrating the technique).


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)

Fluoroscopy images of the transforaminal epidural dry needling procedure. The anteroposterior (A) and lateral (B) fluoroscopy images are from a patient undergoing the intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Fluoroscopy images of the transforaminal epidural dry needling procedure. The anteroposterior (A) and lateral (B) fluoroscopy images are from a patient undergoing the intervention.
Mentions: At the level of the stenosis, the flexed Round Needle was inserted 8-12 cm lateral to the midline with the concave surface facing up. The needle was advanced at a 15-30° angle to the horizontal plane until the flexed tip contacted the lumbar spine (Figure 3A). Then the C-arm was turned to the lateral view. The tip of the needle was positioned between the anterior side of the facet joint and pedicle (Figure 3B), and was then advanced to the outer-third of the pedicle (Figure 1B). It was advanced further, to the inner line of pedicle, as an additional treatment for the anterior epidural space if the previous posterior epidural approach did not produce a favourable treatment outcome. The needle was advanced medially and backed laterally a few millimetres along the canal side of the inferior articular process between the anterior side of the facet joint and pedicle. The procedure was complete when we felt a marked reduction in resistance at the tip of the needle. The procedure was performed bilaterally at each level of the stenosis (Additional file 1: A movie demonstrating the technique).

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