Journal of Clinical Medicine

Research

15 pages, 1920 KiB

Open AccessArticle

Sub-Perception and Supra-Perception Spinal Cord Stimulation in Chronic Pain Syndrome: A Randomized, Semi-Double-Blind, Crossover, Placebo-Controlled Trial

by Paweł Sokal, Agnieszka Malukiewicz, Sara Kierońska, Joanna Murawska, Cezary Guzowski, Marcin Rudaś, Dariusz Paczkowski, Marcin Rusinek and Mateusz Krakowiak

J. Clin. Med. 2020, 9(9), 2810; https://doi.org/10.3390/jcm9092810 - 31 Aug 2020

Cited by 8 | Viewed by 2513

Abstract

Background: The introduction of modern sub-perception modalities has improved the efficacy of spinal cord stimulation (SCS) in refractory pain syndromes of the trunk and lower limbs. The objective of this study was to evaluate the effectiveness of low and high frequency SCS among [...] Read more.

Background: The introduction of modern sub-perception modalities has improved the efficacy of spinal cord stimulation (SCS) in refractory pain syndromes of the trunk and lower limbs. The objective of this study was to evaluate the effectiveness of low and high frequency SCS among patients with chronic pain. Material and methods: A randomised, semi-double-blind, placebo controlled, four period (4 × 2 weeks) crossover trial was conducted from August 2018 to January 2020. Eighteen patients with SCS due to failed back surgery syndrome and/or complex regional pain syndrome were randomised to four treatment arms without washout periods: (1) low frequency (40-60 Hz), (2) 1 kHz, (3) clustered tonic, and (4) sham SCS (i.e., placebo). The primary outcome was pain scores measured by visual analogue scale (VAS) preoperatively and during subsequent treatment arms. Results: Pain scores (VAS) reported during the preoperative period was M (SD) = 8.13 (0.99). There was a 50% reduction in pain reported in the low frequency tonic treatment group (M (SD) = 4.18 (1.76)), a 37% reduction in the 1 kHz treatment group (M (SD) = 5.17 (1.4)), a 34% reduction in the clustered tonic settings group (M (SD) = 5.27 (1.33)), and a 34% reduction in the sham stimulation group (M (SD) = 5.42 (1.22)). The reduction in pain from the preoperative period to the treatment period was significant in each treatment group (p < 0.001). Overall, these reductions were of comparable magnitude between treatments. However, the modality most preferred by patients was low frequency (55% or 10 patients). Conclusions: The pain-relieving effects of SCS reached significance and were comparable across all modes of stimulation including sham. Sub-perception stimulation was not superior to supra-perception. SCS was characterised by a high degree of placebo effect. No evidence of carryover effect was observed between subsequent treatments. Contemporary neuromodulation procedures should be tailored to the individual preferences of patients. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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11 pages, 5073 KiB

Open AccessArticle

Feasibility of Using the Epidural Space Detecting Device (EPI-Detection^TM) for Interlaminar Cervical Epidural Injection

by Jiin Kang, Sam Sun Park, Chul Hwan Kim, Eui Chul Kim, Hyung Cheol Kim, Hyungseok Jeon, Kyung Hyun Kim and Dong Ah Shin

J. Clin. Med. 2020, 9(8), 2355; https://doi.org/10.3390/jcm9082355 - 23 Jul 2020

Cited by 2 | Viewed by 3594

Abstract

Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-Detection^TM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and [...] Read more.

Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-Detection^TM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-Detection^TM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-Detection^TM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm² vs. 380.3 ± 340.9 mGy·cm², respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-Detection^TM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-Detection^TM may help perform ILCEI safely. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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13 pages, 1829 KiB

Open AccessArticle

Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study

by Yul Oh, Dong Ah Shin, Dong Joon Kim, Woojong Cho, Taejun Na, Jeong-Gil Leem, Jin-Woo Shin, Doo-Hwan Kim, Kyung-Don Hahm and Seong-Soo Choi

J. Clin. Med. 2020, 9(4), 1144; https://doi.org/10.3390/jcm9041144 - 16 Apr 2020

Cited by 9 | Viewed by 2595

Abstract

Post-laminectomy syndrome (PLS) is characterized by chronic pain and complex pathological entity after back surgery. An epidural adhesiolysis is considered an effective treatment option for lumbar PLS. In this study, we retrospectively analyzed the outcome and evaluated the predictive factors of combined epidural [...] Read more.

Post-laminectomy syndrome (PLS) is characterized by chronic pain and complex pathological entity after back surgery. An epidural adhesiolysis is considered an effective treatment option for lumbar PLS. In this study, we retrospectively analyzed the outcome and evaluated the predictive factors of combined epidural adhesiolysis and balloon decompression using inflatable balloon catheters in lumbar PLS cases. One hundred and forty-seven subjects were retrospectively assessed and analyzed. The percentages of patients who exhibited treatment response were 32.0%, 24.5%, and 22.4% of the study population at 1, 3, and 6 months, respectively. In multivariate logistic regression analysis, the pain duration was independently associated with the treatment response six months after combined epidural adhesiolysis and balloon decompression (odds ratio = 0.985, 95% confidence interval = 0.971–0.999; p = 0.038). In addition, the receiver operating characteristic curve analysis showed that the area under the curve of pain duration after lumbar surgery was 0.680 (95% confidence interval = 0.597–0.754, p = 0.002), with an optimal cut-off value of ≤14 months, sensitivity of 51.5%, and specificity of 81.4% Our results suggest that an early intervention using combined epidural adhesiolysis and balloon decompression in lumbar PLS patients may be associated with a favorable outcome, even though it has limited effectiveness. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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11 pages, 1543 KiB

Open AccessArticle

Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations

by Chan-Sik Kim, Yeon-Jin Moon, Jae Won Kim, Dong-Min Hyun, Shill Lee Son, Jin-Woo Shin, Doo-Hwan Kim, Seong-Soo Choi and Myong-Hwan Karm

J. Clin. Med. 2020, 9(4), 981; https://doi.org/10.3390/jcm9040981 - 1 Apr 2020

Cited by 4 | Viewed by 2942

Abstract

Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter [...] Read more.

Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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9 pages, 1752 KiB

Open AccessArticle

Percutaneous Endoscopic Cervical Discectomy versus Anterior Cervical Discectomy and Fusion: A Comparative Cohort Study with a Five-Year Follow-Up

by Yong Ahn, Han Joong Keum and Sang Ha Shin

J. Clin. Med. 2020, 9(2), 371; https://doi.org/10.3390/jcm9020371 - 29 Jan 2020

Cited by 43 | Viewed by 4668

Abstract

Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. [...] Read more.

Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. We compared the surgical results of PECD and ACDF. Data from patients treated with single-level PECD (n = 51) or ACDF (n = 64) were analyzed. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved in both groups. The rates of excellent or good results were 88.24% and 90.63% in the PECD and ACDF group, respectively. The revision rates were 3.92% and 1.56% in the PECD and ACDF group, respectively. Operative time, hospital stay, and time to return to work were reduced in the PECD group compared to the ACDF group (p < 0.001). The five-year outcomes of PECD were comparable to those of conventional ACDF. PECD provided the typical benefits of minimally invasive surgery and may be an effective alternative for treating soft cervical disc herniation. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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8 pages, 631 KiB

Open AccessArticle

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

by Sooho Lee, Taeha Lim, Young-Seob Lim and Young Uk Kim

J. Clin. Med. 2020, 9(1), 214; https://doi.org/10.3390/jcm9010214 - 13 Jan 2020

Cited by 1 | Viewed by 2465

Abstract

Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in [...] Read more.

Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm² in control subjects and 88.77 ± 18.52 mm² in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm², with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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10 pages, 1052 KiB

Open AccessArticle

Kambin’s Triangle Approach versus Traditional Safe Triangle Approach for Percutaneous Transforaminal Epidural Adhesiolysis Using an Inflatable Balloon Catheter: A Pilot Study

by Ho Young Gil, Sangmin Jeong, Hyunwook Cho, Eunjoo Choi, Francis Sahngun Nahm and Pyung-Bok Lee

J. Clin. Med. 2019, 8(11), 1996; https://doi.org/10.3390/jcm8111996 - 15 Nov 2019

Cited by 9 | Viewed by 10482

Abstract

Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter [...] Read more.

Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter can reduce the patients’ pain and improve their functional capacity. We aimed to evaluate the safety and efficacy of the Kambin’s-triangle approach for PTFA using an inflatable balloon catheter and compare this approach to the traditional safe-triangle approach. Thirty patients with chronic unilateral L5 radiculopathy were divided into two groups: the safe-triangle-approach and Kambin’s-triangle-approach groups, with 15 patients each. The success rate of the procedure was assessed. Pain and dysfunction were assessed using the Numerical Rating Scale and Oswestry Disability Index, respectively, before the procedure and at 1 and 3 months after the procedure. The success rate of the procedure was high in both the groups, with no significant difference between the groups. The Numerical Rating Scale and Oswestry Disability Index scores significantly decreased 3 months after the procedure in both the groups, with no significant difference between the groups. For patients in whom the safe-triangle approach for PTFA is difficult, the Kambin’s-triangle approach could be an alternative. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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9 pages, 1755 KiB

Open AccessArticle

Factors Associated with Successful Response to Balloon Decompressive Adhesiolysis Neuroplasty in Patients with Chronic Lumbar Foraminal Stenosis

by Yul Oh, Doo-Hwan Kim, Jun-Young Park, Gyu Yeul Ji, Dong Ah Shin, Sang Won Lee, Jin Kyu Park, Jin-Woo Shin and Seong-Soo Choi

J. Clin. Med. 2019, 8(11), 1766; https://doi.org/10.3390/jcm8111766 - 23 Oct 2019

Cited by 10 | Viewed by 2910

Abstract

Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from [...] Read more.

Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from epidural steroid injection or even epidural neuroplasty with a balloon-less catheter. However, exact indications or predictive factors for epidural balloon neuroplasty have not been fully evaluated. Therefore, to assess associated factors that could affect a favorable outcome, we analyzed a prospectively collected multicenter cohort of patients with chronic refractory lumbar foraminal stenosis after balloon neuroplasty. At the 6-month point in follow-up, 92 (44.4%) patients among 207 subjects were classified as successful responders according to a robust combination of outcome measures. Multivariate logistic regression analysis also showed that mild grade lumbar foraminal stenosis may be an independent factor associated with a successful response 6 months after balloon neuroplasty (odds ratio = 2.829; 95% confidence interval = 1.351–5.923; p = 0.006). However, we found that there were 29.4% and 24.6% successful responders with moderate and severe foraminal stenosis, respectively. Attempting balloon neuroplasty in refractory lumbar foraminal stenosis, especially mild grade, may be worthwhile. Full article

(This article belongs to the Special Issue Interventional Procedures for Chronic Spinal Pain)

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