1. 2013;16;E37-E43Effectiveness of Percutaneous Transforaminal Adhesiolysis in Patients with Lumbar Neuroforaminal Spinal Stenosis
   Prospective Evaluation
   Chan Hong Park, MD, PhD, and Sang-Ho Lee, MD, PhD.

BACKGROUND: Lumbar foraminal spinal stenosis (LFSS) is a narrowing of the bony exit of a nerve root, which causes mechanical compression of spinal nerve roots. Low back pain and/or leg pain, and possibly neurogenic claudication, may result due to mechanical neural compression. Transforaminal epidural steroid injections (TFESIs) are commonly used for treating LFSS. Patients refractory to TFESIs may benefit from percutaneous epidural adhesiolysis.

OBJECTIVE: Our intent was to assess transforaminal adhesiolysis (TFA) as treatment for LFSS, analyzing patient response by severity of stenosis and evaluating the short-term effectiveness of TFA.

STUDY DESIGN: Prospective study.

METHODS: Following IRB approval, 35 patients with LFSS were enrolled, all of whom underwent magnetic resonance imaging (MRI) of the lumbar spine. Sagittal MRI views were evaluated to grade the severity of LFSS. TFA was routinely conducted in the operating room. One hour after the procedure, each patient received 6 mL of 10% sodium chloride, infused over 30 minutes, with monitoring. Posttreatment outcomes were determined at 2 weeks and 3 months using a 5-point patient satisfaction scale. To test predictive value, patients were stratified by response (improvement versus no improvement).

RESULTS: Improvement (defined as little pain, moderate pain, or no pain) was observed in 25 patients (71.4%) at 2 weeks and in 22 patients (62.8%) at 3 months following the procedure. Among patients showing improvement, those with Grade 3 spinal stenosis outnumbered those with Grade 2. At the 3-month follow-up, no statistically significant correlations between pain relief and the grade of LFSS was evident.

LIMITATIONS: Secondary outcomes were not measured and the follow-up period was relatively brief.

CONCLUSION: Short-term results indicate that percutaneous TFA is an effective treatment for LFSS, although therapeutic outcomes and the severity of LFSS showed no correlation.