PDF(Pubmed)
Abstract：
Introduction Lumbar and leg pain can be caused by many factors, including scar tissue in the epidural space. Epidural fibrosis may cause chronic radicular low back pain. Adhesions in the epidural space may occur due to surgical or non-surgical reasons. Epidural adhesiolysis, i.e., neuroplasty, eliminates the pain-causing effects of scar tissue by releasing the nerve from the scar tissue or decompressing the nerve. In light of this information, this study was conducted to evaluate the effectiveness of percutaneous epidural neuroplasty interventions performed in the algology clinic in patients with lumbar epidural fibrosis who have and have not undergone lumbar surgery. Methods The sample of this retrospective study consisted of 72 patients with chronic radicular low back pain, finding fibrosis in the epidural region on contrast-enhanced magnetic resonance imaging (MRI), filling defect after epidurogram, and caudal epidural neuroplasty. Patients\' visual analog scale (VAS) and Oswestry disability index (ODI) scores, pregabalin, duloxetine, and opioid doses were evaluated before and one month and six months after having neuroplasty. Results The VAS and ODI scores and pregabalin, duloxetine, and opioid doses decreased significantly in patients who had had caudal epidural neuroplasty at post-procedure endpoints compared to before the procedure (p<0.001). The paired temporal comparisons of the data of the patients who underwent epidural neuroplasty procedures before the procedure, one month after the procedure, and six months after the procedure revealed significant differences in the VAS and ODI scores (p<0.001). Additionally, the analysis of patients\' VAS scores revealed that the pre-procedure VAS scores decreased significantly more one month after the procedure in patients without a history of lumbar surgery than in patients with a history of lumbar surgery. Conclusions The findings of our study demonstrated that fluoroscopy-guided percutaneous epidural neuroplasty alleviated pain and improved physical functions and quality of life. In conclusion, percutaneous epidural neuroplasty is a safe and effective treatment method for patients with lumbar epidural fibrosis.
摘要：
引言腰腿痛可由多种因素引起，包括硬膜外腔的疤痕组织.硬膜外纤维化可引起慢性神经根性下腰痛。硬膜外腔的粘连可能由于手术或非手术原因而发生。硬膜外粘连松解术,即，神经成形术,通过从瘢痕组织释放神经或减压神经来消除瘢痕组织的疼痛效应。根据这些信息，本研究的目的是评估经皮硬膜外神经成形术介入治疗对腰椎硬膜外纤维化患者的有效性。方法回顾性研究72例慢性神经根性下腰痛患者,在对比增强磁共振成像（MRI）上发现硬膜外区域的纤维化，表造影后的填充缺陷，和硬膜外神经成形术.患者视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分，普瑞巴林,度洛西汀,和阿片类药物的剂量在神经成形术前和术后1个月和6个月进行评估.结果VAS和ODI评分及普瑞巴林,度洛西汀,与手术前相比,在手术后终点进行了硬膜外腔神经成形术的患者的阿片类药物剂量显著降低(p<0.001).术前接受硬膜外神经成形术的患者数据的配对时间比较，手术后一个月，术后6个月显示VAS和ODI评分存在显著差异(p<0.001)。此外,对患者\'VAS评分的分析显示,与有腰椎手术史的患者相比,无腰椎手术史的患者术前VAS评分在术后1个月内显著下降.结论我们的研究结果表明，透视引导下经皮硬膜外神经成形术减轻了疼痛，改善了身体功能和生活质量。总之,经皮硬膜外神经成形术是治疗腰椎硬膜外纤维化安全有效的方法。
