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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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Transforaminal epidural contrast injection test to demonstrate that the specially designed needle effectively reached the target structures. The curved spinal injection needle used in the test (A). The anteroposterior fluoroscopy image shows a needle that has been advanced transforaminally at the L4-L5 level in the same manner as that used in the treatment and contrast agent flowing through the epidural space (B). The lateral fluoroscopy image. The triangle (▼) indicates contrast agent in the anterior epidural space when the needle was used in its original straight form. The arrow (↑) indicates contrast agent in the posterior epidural space when the curved needle was used. The curved needle contacted the canal side of the inferior articular process between the facet joint and pedicle (C).
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Figure 4: Transforaminal epidural contrast injection test to demonstrate that the specially designed needle effectively reached the target structures. The curved spinal injection needle used in the test (A). The anteroposterior fluoroscopy image shows a needle that has been advanced transforaminally at the L4-L5 level in the same manner as that used in the treatment and contrast agent flowing through the epidural space (B). The lateral fluoroscopy image. The triangle (▼) indicates contrast agent in the anterior epidural space when the needle was used in its original straight form. The arrow (↑) indicates contrast agent in the posterior epidural space when the curved needle was used. The curved needle contacted the canal side of the inferior articular process between the facet joint and pedicle (C).

Mentions: A transforaminal epidural contrast injection test using a spinal needle was conducted to examine whether the flexed Round Needle effectively reached the posterior epidural space, the primary target of our intervention. When the spinal needle was advanced transforaminally in its original straight form, we found it difficult to contact the canal side of the inferior articular process between the facet joint and pedicle and advance further into the anterior epidural space. However, when the tip was curved (Figure 4A), one could easily contact the canal side of the inferior articular process between the facet joint and pedicle and reach the posterior epidural space (Figures 4B and 4C), indicating that the bent needle allowed us to reach the primary target of our intervention.


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)

Transforaminal epidural contrast injection test to demonstrate that the specially designed needle effectively reached the target structures. The curved spinal injection needle used in the test (A). The anteroposterior fluoroscopy image shows a needle that has been advanced transforaminally at the L4-L5 level in the same manner as that used in the treatment and contrast agent flowing through the epidural space (B). The lateral fluoroscopy image. The triangle (▼) indicates contrast agent in the anterior epidural space when the needle was used in its original straight form. The arrow (↑) indicates contrast agent in the posterior epidural space when the curved needle was used. The curved needle contacted the canal side of the inferior articular process between the facet joint and pedicle (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Transforaminal epidural contrast injection test to demonstrate that the specially designed needle effectively reached the target structures. The curved spinal injection needle used in the test (A). The anteroposterior fluoroscopy image shows a needle that has been advanced transforaminally at the L4-L5 level in the same manner as that used in the treatment and contrast agent flowing through the epidural space (B). The lateral fluoroscopy image. The triangle (▼) indicates contrast agent in the anterior epidural space when the needle was used in its original straight form. The arrow (↑) indicates contrast agent in the posterior epidural space when the curved needle was used. The curved needle contacted the canal side of the inferior articular process between the facet joint and pedicle (C).
Mentions: A transforaminal epidural contrast injection test using a spinal needle was conducted to examine whether the flexed Round Needle effectively reached the posterior epidural space, the primary target of our intervention. When the spinal needle was advanced transforaminally in its original straight form, we found it difficult to contact the canal side of the inferior articular process between the facet joint and pedicle and advance further into the anterior epidural space. However, when the tip was curved (Figure 4A), one could easily contact the canal side of the inferior articular process between the facet joint and pedicle and reach the posterior epidural space (Figures 4B and 4C), indicating that the bent needle allowed us to reach the primary target of our intervention.

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