1. 2013;16;E531-E536Evaluation of Prognostic Predictors of Percutaneous Adhesiolysis Using a Racz Catheter for Post Lumbar Surgery Syndrome or Spinal Stenosis
   Retrospective Evaluation
   Eunjoo Choi, MD, Francis Sahngun Nahm, MD, and Pyung-Bok Lee, MD, PhD.

BACKGROUND:  Percutaneous adhesiolysis (PA) is considered to be a reasonable nonoperative treatment for herniation of intervertebral disc (HIVD), spinal stenosis, and post-lumbar-surgery syndrome (PLSS). The success of PA depends on the removal of epidural fibrosis and drug delivery to the target region. However, prognostic predictors of the effects of PA are not well known.

OBJECTIVE:  The aim of this study was to evaluate prognostic predictors of PA using a Racz catheter for patients with PLSS or spinal stenosis.

STUDY DESIGN: Retrospective assessment.

METHODS: PA using a Racz catheter was performed on 78 patients. We assessed the effectiveness of PA at pretreatment, 2 weeks, 3 months, and 6 months following the procedure. Effectiveness was defined as a 50% or more reduction of the Numeric Rating Scale (NRS) for back and leg pain or a 40% or more reduction of the Oswestry Disability Index (ODI) following the procedure. Data collected for each patient included age, gender, BMI, grade and location of stenosis in magnetic resonance imaging (MRI), symptom durations, and history of previous lumbar surgery. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for each variable were analyzed by logistic regression.

RESULTS: PA using a Racz catheter was more effective in patients with no previous lumbar surgery (OR, 7.426; 95% CI, 1.820–30.302; P = 0.005) or root compression with HIVD or foraminal stenosis (OR, 5.479; 95% CI, 1.137–26.391; P = 0.036). Other included factors were not related to PA effectiveness.

LIMITATIONS: The number of patients examined in this study was relatively small.

CONCLUSION: Good prognostic predictors were identified as no previous lumbar surgery or root compression with HIVD or foraminal stenosis. These results are expected to contribute to the establishment of indications for PA.