title: Transforaminal hypertonic saline for the treatment of lumbar lateral canal stenosis: a double-blinded, randomized, active-control trial.
abstract: BACKGROUND
  Degenerative lumbar spinal stenosis is one of the most common causes of chronic lower back pain and radiculopathy. Spinal stenosis is anatomically classified as central and lateral spinal canal stenosis. Many treatment modalities and techniques, including surgery and epidural injection, have been used to manage the pain. However, the effect of hypertonic saline injection via the transforaminal approach has not yet been studied.
  
  
  OBJECTIVE
  The aim of this study is to determine the effect of adding hypertonic saline to conventional transforaminal epidural steroid injections (TFEI) to provide pain relief for chronic radiculopathy patients secondary to lateral canal spinal stenosis.
  
  
  METHODS
  A double-blind, randomized, active-control trial.
  
  
  METHODS
  An interventional pain management practice in a hospital, Republic of Korea.
  
  
  METHODS
  Two groups: the hypertonic group received hypertonic saline combined with triamcinolone and the control group received normal saline combined with triamcinolone. A total of 68 patients were randomly allocated into either 2 groups by a computer-generated randomization program. Twenty-seven patients in the hypertonic group and 26 patients in the control group were assessed. A total of 53 patients were included in this analysis. Outcome measures were taken at baseline, one, 2, 3, 4, and 6 months post-procedure. The primary outcome measures included the numerical rating scale (NRS) and the proportion of substantial responders. The secondary outcome measures included the Oswestry disability index (ODI), the proportion of substantial and moderate responders, and patient satisfaction.
  
  
  RESULTS
  Transforaminal epidural injection of steroids, with or without the addition of 10% hypertonic saline, was effective and provided significant pain relief with the improvement of functional outcome within 4 months. The addition of hypertonic saline was superior in efficacy compared with conventional TFEI at 3 months follow-up. The differences in the absolute pain scores did not demonstrate statistical significance between the 2 groups. The reduction in pain intensity from the baseline was greater in the hypertonic group and demonstrated higher rates of satisfaction. The use of hypertonic saline also extended the duration of significant pain relief to 6 months compared with baseline.
  
  
  CONCLUSIONS
  The lack of placebo group and small sample size.
  
  
  CONCLUSIONS
  Superior short-term pain relieving efficacy, but limited long-term effects of hypertonic saline, when added to TFEIs.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Korea.
authors.forename: Won Uk
authors.initials: WU
authors.lastname: Koh
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Choi
authors.forename: Seung Yong
authors.initials: SY
authors.lastname: Park
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Joo
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae Do
authors.initials: JD
authors.lastname: Lee
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Shin
authors.forename: Jeong Hun
authors.initials: JH
authors.lastname: Suh
authors.forename: Jeong Gil
authors.initials: JG
authors.lastname: Leem
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Shin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D008161:Lumbosacral Region / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D014221:Triamcinolone / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D012462:Saline Solution, Hypertonic; D014221:Triamcinolone