Preliminary results of the clinical effectiveness of percutaneous adhesiolysis using a Racz catheter in the management of chronic pain due to cervical central stenosis.

BACKGROUND

Cervical central stenosis (CCS) is a narrowing of the spinal canal that can cause mechanical compression of the spinal nerve and roots, leading to neck pain and/or radicular pain. Cervical epidural steroid injections are commonly used in the treatment of CCS. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis with a targeted drug delivery.

OBJECTIVE

The aim of our study is to evaluate the effectiveness of percutaneous cervical epidural adhesiolysis in patients with chronic posterior neck pain and upper extremity pain due to CCS.

STUDY DESIGN

This was a preliminary, prospective study.

METHODS

Thirty-nine patients with CCS were enrolled and all subjects underwent cervical spine magnetic resonance imaging. All patients received percutaneous adhesiolysis and appropriate placement of a Racz catheter, followed by an injection of 5 mL of 0.2 % preservative-free ropivacaine containing 1,500 units of hyaluronidase and 4 mg of dexamethasone. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, after which the catheter was removed. Outcome measures were obtained using a 5-point patient's satisfaction scale at 2 weeks and at 6 months post-treatment. To evaluate treatment effectiveness, we divided the patients into 2 groups according to their treatment response.

LIMITATIONS

Secondary outcomes were not measured. The study did not include a long-term follow-up period or control group.

RESULTS

Improvement designated as reports of moderate pain, little pain, and no pain was observed in 30 patients (77.0 %) at 2 weeks and 28 patients (71.8 %) at 6 months after the procedure. There was no statistically significant correlation between pain relief and the severity of CCS.

CONCLUSION

Percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic posterior neck and upper extremity pain due to cervical central spinal stenosis, although there is no correlation between therapeutic response and the grade of CCS.