Lumbosacral Epiduroscopy Findings Predict Treatment Outcome

作者：Bosscher Hemmo A^*; Heavner James E

来源：Pain Practice, 2014, 14(6): 506-514.

DOI：10.1111/papr.12112

• lumbosacral epiduroscopy
• low back pain
• radiating pain
• inflammation
• vascularity
• fibrosis
• outcome prediction

Objective: The aim of this study was to evaluate the significance of diagnostic markers obtained through epiduroscopy by evaluating the accuracy of outcome prediction after treatment of epidural pathology using epiduroscopy. %26lt;br%26gt;Design: A prospective observational study of 139 patients was performed. Patients with chronic low back and leg pain were included. Of the 150 patients who underwent epiduroscopy in the year 2008 at a US hospital, 139 were available for evaluation at 1 month. %26lt;br%26gt;Study: Outcome of treatment was predicted based on direct visual information (hyperemia, vascularity, and fibrosis) and mechanical information (pain to touch, contrast spread, and patency) obtained through epiduroscopy. %26lt;br%26gt;Main Outcome Measures: Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios. %26lt;br%26gt;Results: A prediction of outcome was made in 114 of 139 patients (82%). This prediction was correct in 89 of these 114 patients (accuracy of 78%). The sensitivity and specificity of epiduroscopy with respect to the prediction of outcome were 75% and 82%, respectively. These results were statistically significant (P %26lt; 0.01). %26lt;br%26gt;In 25 of the 139 patients (18%), discrete epidural pathology was not observed. Nine of these 25 patients reported good relief after epiduroscopy. The sensitivity and specificity of epiduroscopy in the diagnosis of epidural pathology were 91% and 39%, respectively. These results were not statistically different (P %26gt; 0.1). %26lt;br%26gt;Conclusion: Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value.

• 出版日期2014-7