Spinal Stenosis, Lumbar Region, With Neurogenic Claudication
Conditions
Keywords
Lumbosacral epiduroscopy, spinal stenosis, magnetic resonance imaging, intraoperative neurophysiological monitoring, neurogenic claudication
Brief summary
It will be done a prospective Study involving 38 patients with lumbar stenosis. A magnetic resonance (MR) imaging study and a electromyographic study will be done previously and 3 months after the epiduroscopy to confirm radiologic or neurophysiological changes. During the technic it will be used different instruments, an endoscope developed for its use in the epidural space (Resascope), a Fogarty balloon (Resaloon) to dilate the space near the epidural recess where it will be try to decrease the ligamentum flavum using the Resaflex, an instrument with Quantum Molecular Resonance for tissue coablation, in order to get less symptomatic lumbar stenosis. The investigators will compare qualitative and quantitative variables at baseline and 1, 3, 6, ant 12 months after the epiduroscopy.
Detailed description
The investigators perform the Interventional Endoscopic Spinal Surgical (IESS) ,with the different instruments mentioned above. The Resaflex wich use Quantum Molecular Resonance, through combination of different frequencies in the range of the radio-frequency, emit quantum in resonance and produce lesion and coagulation; The objective is to reach the ligamentum flavum doing lesions to diminish the stenosis caused by hypertrophic ligamentum over all in the recess area near the radicular nerve. To increase the security of the procedure the investigators introduce for the first time , neurophysiological monitoring.
Interventions
PROCEDUREEpiduroscopy
Using epiduroscopy to treat the ligamentum flavum hypertrophy with Resaflex ,an instrument with Quantum Molecular Resonance for tissue coablation.
Sponsors
Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patient with indication for epiduroscopy in the usual clinical practice * Neurogenic claudication * Lumbar pain for more than 6 months * Numerical rating scale \>6 * No response with medical treatment * No response with other interventional treatment: epidurolysis
Exclusion criteria
* Psychiatric disorders * Opioid addiction * Acute organic disease * Severe chronic organic disease * Vasculo-cerebral disease * Coagulation alterations * Ofthalmologic disease * Allergic * Infections * Impossibility to understand the procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quantitative measurements in lumbar magnetic resonance imaging | Baseline | Measure in mm of ligamentum flavum at the level with major stenosis at the medium area of the ligamentum and in the recess |
| Qualitative changes in lumbar magnetic resonance imaging | Baseline | Schizas classification( A:no stenosis, B: moderate; C:severe) at the level where there are major stenosis |
| Numerical rating scale | Baseline | Pain from 0 (no pain) to 10 (worst pain imaginable) |
| Likert Scale to record the percentage of improvement | baseline | Percentage of improvement: 1 (\>75% worst) 2 \>50% worst; 3 (\>25% worst); 4 (no changes); 5 ( 25% better); 6 (50% better); 7 (75% better) |
| EuroQualityofLife visual analogue scale (EQ VAS) | Baseline | The EQ visual analogue scale (EQ VAS). VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints wich comes from 0 to 100 are labelled 'The best health you can imagine' (100) and 'The worst health you can imagine' (0). This can be used as a quantitative measure of health outcome. The higher values indicates a better outcome. |
| EuroQualityofLife Five-Dimensions Five-Levels Questionnaire(EQ-5D-5L) | Baseline | The 5-level EQ-5D version (EQ-5D-5L) consists of: 1- The EQ-5D descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. This results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. |
| Oswestry Disability Index (ODI) | Baseline | Low back pain disability questionnaire: is a validated, 10-point patient-reported outcome questionnaire. It is considered the 'gold standard' for measuring disability and quality of life (QoL) impairment for adults with low back pain (LBP).The 10 factors which constitute the ODI criteria for assessing patients' functional impairment are pain intensity, ease of personal care, lifting, working, sitting, stand-ing, sleeping, sex life, social life and travelling. Each of the 10 questions is scored from 0 to 5, giving a maximum score of 50. The total score is then converted into a percentage by multiplying it by 2. Scores are stratified into severity: 0-20, minimal disability; 21-40, moderate disability; 41-60, severe disability; 61-80, crippling back pain; 81-100, these patients are either bed-bound or have an exaggeration of their symptoms. In order for the results to be deemed clinically significant, a change in the patient's score of 10% or more is required |
| Zurich questionnaire | Baseline | Claudication test:The scale relates to symptoms over the past month. There are 12 questions for all patients, and a further 6 questions to measure treatment outcome (for those who have had treatment). The The Zurich Claudication Questionnaire consists of three subscales: 1. Symptom severity scale (questions I-VII) \[further subdivided into pain domain (questions I-IV) and a neuroischemic domain (questions V-VII)\]: Possible range of the score is 1 to 5. 2. Physical function scale (questions VIII-XII): Possible range of scores is 1 to 4. 3. Patient's satisfaction with treatment scale (questions XIII-XVIII): the range of the scale is 1 to 4. |
Countries
Spain
Outcome results
None listed