title: Does improvement in epidurography following percutaneous epidural neuroplasty correspond to patient outcome?
abstract: OBJECTIVE
  The positive effects of percutaneous epidural neuroplasty (PEN) likely result from elimination of fibrous tissue. However, a direct link between epidural adhesions and pain symptoms is debatable. We tested the hypothesis that epidurographic improvements correspond to improved patient outcome.
  
  
  METHODS
  In this prospective study, patients with a filling defect on initial epidurography underwent PEN. Two weeks later, contrast agent distribution around the target area was assessed with repeat epidurography. A successful treatment was defined as over a 50% reduction in visual analog scale (VAS) score 2 weeks postprocedure. The demographic data, history of lumbar spine operation, target nerve, diagnosis, VAS scores, degree of epidurographic improvement, and patient satisfaction were compared between the successful treatment group (Group I) and unsuccessful treatment group (Group II).
  
  
  RESULTS
  Seventy-nine patients were included. Epidurographic findings improved in 67.1% of patients 2 weeks after the procedure. Following PEN, the mean VAS scores of all patients were significantly decreased at 2 weeks (4.12 ± 2.34), 1 month (3.56 ± 2.30), 3 months (3.84 ± 2.45), and 6 months (4.13 ± 2.71) compared with the initial scores (7.82 ± 1.78). In the comparison between Groups I and II, the rate of epidurographic improvement in Group I was higher than in Group II (P = 0.022). Satisfaction in patients that had epidurographic improvement (median satisfaction: 4) was higher than in patients that did not have epidurographic improvement (median satisfaction: 3; P = 0.003).
  
  
  CONCLUSIONS
  The epidurographic changes following PEN correlate with patient-assessed pain relief and satisfaction.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Jae Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Francis Sahngun
authors.initials: FS
authors.lastname: Nahm
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Pyung Bok
authors.initials: PB
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D004824:Epidural Space / Q000000981:diagnostic imaging* / Q000187:drug effects; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D017060:Patient Satisfaction; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: epidural injections; epidural neuroplasty; epidurography; low back pain; treatment outcome