Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle

Abstract

Background. This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS). Methods. Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis. Results. The average follow-up period was 12.9 1.1 months. The visual analogue scale (VAS) pain score was reduced from 7.3 2.0 to 4.6 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 17.2 to 25.5 12.6% and the average self-rated improvement was 52.6 33.1%. The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale. Conclusions. These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS. © 2010 Ahn et al; licensee BioMed Central Ltd.