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Percutaneous epidural adhesiolysis using inflatable balloon catheter and balloon-less catheter in central lumbar spinal stenosis with neurogenic claudication: A randomized controlled trial

Cited 13 time in Web of Science Cited 20 time in Scopus
Authors

Karm, Myong-Hwan; Choi, Seong-Soo; Kim, Doo-Hwan; Park, Jun-Young; Lee, Sukyung; Park, Jin Kyu; Suh, Young Joong; Leem, Jeong-Gil; Shin, Jin Woo

Issue Date
2018-11
Publisher
American Society of Interventional Pain Physicians
Citation
Pain Physician, Vol.21 No.6, pp.593-605
Abstract
Background: When conventional interventional procedures fail, percutaneous epidural adhesiolysis (PEA), which has moderate evidence for successful treatment of lumbar spinal stenosis (LSS), has been recommended over surgical treatments. In a previous study, we demonstrated the efficacy of a newly developed inflatable balloon catheter for overcoming the access limitations of pre-existing catheters for patients with severe stenosis or adhesions. Objectives: This study compared the treatment response of combined PEA with balloon decompression and PEA only in patients with central LSS over 6 months of follow-up. Study Design: This study used a randomized, single-blinded, active-controlled trial design. Setting: This study took place in a single-center, academic, outpatient interventional pain management clinic. Methods: This randomized controlled study included 60 patients with refractory central LSS who suffered from chronic lower back pain and/or lumbar radicular pain. Patients failed to maintain improvement for > 1 month with epidural steroid injection or PEA using a balloon-less catheter. Patients were randomly assigned to one of 2 interventions: balloon-less (n = 30) and inflatable balloon catheter (n = 30). The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), Global Perceived Effect of Satisfaction (GPES), and Medication Quantification Scale III were each measured at 1, 3, and 6 months after PEA. Results: There was a significant difference between groups in NRS-11 reduction = 50% (or 4 points), ODI reduction = 30% (or 10 points), GPES = 6 and = 4 points at 6 months, and NRS-11 reduction = 50% (or 4 points) at 3 months after PEA (P < .03). The proportion of successful responders was higher in the balloon group than in the balloon-less group throughout the total follow-up period. Furthermore, there was a statistically significant difference between groups at 6 months after PEA (P = .035). Limitations: The results may vary according to the definition of successful response. Follow-up loss in the present study seemed to be high. Conclusion: PEA using the inflatable balloon catheter leads to significant pain reduction and functional improvement compared to PEA using the balloon-less catheter in patients with central LSS.
ISSN
1533-3159
URI
https://hdl.handle.net/10371/200544
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Karm, Myong-Hwan Image

Karm, Myong-Hwan감명환
(기금)조교수
  • School of Dentistry
  • Department of Dentistry
Research Area Dental Anesthesiology, Pain Control, 치과마취, 치과진정법, 통증조절

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