Background: Spinal stenosis is a narrowing of the spinal canal, which causes
mechanical compression of spinal nerve roots. The compression of these nerve roots
can cause low back pain and/or leg pain, as well as neurogenic claudication.
Lumbar epidural steroid injections have commonly been used in patients with
lumbar spinal stenosis (LSS). In cases that are refractory to epidural steroid injections,
percutaneous epidural adhesiolysis has been used.
Objective: The aim of our study is to determine the relationship between the severity
of spinal stenosis and the participants’ response to adhesiolysis, and to evaluate the
mid-term effectiveness of adhesiolysis.
Study Design: A prospective observational study.
Methods: Sixty-six patients with degenerative LSS were enrolled in this prospective
study. All participants underwent lumbar spine magnetic resonance imaging (MRI). The
cross-sectional area of the dural sac was measured on the transverse angled sections
through the central part of the disc on conventional MR images. All percutaneous
adhesiolyses were performed in the operating room. One hour following the procedure,
6 mL of 8% sodium chloride solution was infused during 30 minutes in the recovery
room while the patient underwent monitoring. Outcome measures were obtained
using the 5-point patient satisfaction scale at 2 weeks and 6 months post-treatment.
To evaluate outcome predictors, we divided the participants into 2 groups according to
their response to treatment.
Limitations: Secondary outcomes were not measured and the study did not include
a long-term follow-up period.
Results: Improvement (including reports of slightly improved, much improved, and no
pain) was observed in 49 participants (74.2%) at 2 weeks and 45 participants (66.7%)
at 6 months after the procedure. The dural sac cross-sectional area (DSCSA) did not
differ between participants who reported improvement and those who did not. There
was no statistically significant correlation between pain relief and DSCSA, age, or
participant sex.
Conclusion: Percutaneous adhesiolysis was shown to be effective for the treatment
of LSS, with mid-term result, without affecting DSCSA.
Key words: Low back pain, lumbar spinal stenosis, failed back surgery syndrome,
dural sac, interventional techniques, epidural injection, percutaneous adhesiolysis.