Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle.
BACKGROUND
This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS).


METHODS
Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis.


RESULTS
The average follow-up period was 12.9 +/- 1.1 months. The visual analogue scale (VAS) pain score was reduced from 7.3 +/- 2.0 to 4.6 +/- 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 +/- 17.2 to 25.5 +/- 12.6% and the average self-rated improvement was 52.6 +/- 33.1%. The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale.


CONCLUSIONS
These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS.
Ahn
Kang
K
Chronic Pain Management Centre, Cha Biomedical Centre, Kangnam Cha Hospital, Cha University, 605 Yeoksam-Dong, Kangnam-Ku, Seoul, Republic of Korea.
Jhun
Hyung-Joon
HJ
Lim
Tae-Kyun
TK
Lee
Yong-Seung
YS
D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D009339:Needles / Q000592:standards* / Q000639:trends; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery