Background: Epidural neuroplasty using a Racz catheter has a therapeutic effect. Studies have found no correlation between foraminal stenosis and the outcome of epidural neuroplasty, which is thought to depend on contrast runoff.
Objective: To examine the correlation between the contrast spread pattern and pain reduction in cervical epidural neuroplasty using a Racz catheter.
Study design: Retrospective study.
Setting: An interventional pain-management practice in a university hospital.
Methods: Fluoroscopic images were reviewed retrospectively. The spread of contrast from the neural foramen to a nerve root was called contrast runoff. If the contrast did not spread in this manner, then there was no contrast runoff. We defined successful epidural neuroplasty as a 50% or greater reduction from the pre-procedure numeric rating scale (NRS) score for total pain, and an at least 40% reduction in the neck pain and disability scale (NPDS) score.
Results: This study reviewed 169 patients. Among the patients who had a contrast runoff pattern, the epidural neuroplasty was rated as successful in 96 (74.4%), 97 (75.2%), 86 (66.7%), and 79 (61.2%) cases one, 3, 6, and 12 months after the procedure, respectively. When there was no contrast runoff, the epidural neuroplasty was successful in 12 (30%), 12 (30%), 10 (25%), and 10 (25%) cases at one, 3, 6, and 12 months after the procedure (P < 0.001). Logistic regression of the contrast spread pattern and predicting successful epidural neuroplasty gave similar results. Patients with a contrast runoff pattern had odds ratios of 6.788, 7.073, 6.000, and 4.740 at one, 3, 6, and 12 months, respectively (P < 0.001).
Limitations: This study lacked a control group, and the patients were not classified by their diagnosed disease, such as spinal stenosis, herniated nucleus pulposus, and post-spinal surgery syndrome.
Conclusions: Cervical epidural neuroplasty with a contrast runoff pattern had a higher success rate. Contrast runoff should be observed during neuroplasty, even in the presence of foraminal stenosis.
Key words: Cervical spinal pain, contrast, contrast runoff, epidural neuroplasty, percutaneous adhesiolysis, Racz catheter.