Lumbosacral Epiduroscopy Findings Predict Treatment Outcome
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. Design A prospective observational study of 139 patients was performed. Pati...
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| Veröffentlicht in: | Pain practice 2014-07, Vol.14 (6), p.506-514 |
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| creator | Bosscher, Hemmo A. Heavner, James E. |
| description | 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.
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.
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.
Main Outcome Measures
Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios.
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 0.1).
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. |
| doi_str_mv | 10.1111/papr.12112 |
| format | Article |
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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.
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.
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.
Main Outcome Measures
Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios.
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 < 0.01).
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 > 0.1).
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.</description><identifier>ISSN: 1530-7085</identifier><identifier>EISSN: 1533-2500</identifier><identifier>DOI: 10.1111/papr.12112</identifier><identifier>PMID: 24118805</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chronic Pain - diagnosis ; Chronic Pain - pathology ; Chronic Pain - physiopathology ; Chronic Pain - therapy ; Dura Mater - blood supply ; Dura Mater - pathology ; Endoscopy - instrumentation ; Epidural Space - blood supply ; Epidural Space - pathology ; Female ; fibrosis ; Fluoroscopy ; Humans ; inflammation ; Leg - physiopathology ; low back pain ; Low Back Pain - diagnosis ; Low Back Pain - pathology ; Low Back Pain - physiopathology ; Low Back Pain - therapy ; lumbosacral epiduroscopy ; Lumbosacral Region ; Male ; Middle Aged ; Neurologic Examination ; outcome prediction ; Prognosis ; Prospective Studies ; radiating pain ; Sensitivity and Specificity ; Treatment Outcome ; vascularity ; Young Adult</subject><ispartof>Pain practice, 2014-07, Vol.14 (6), p.506-514</ispartof><rights>2013 World Institute of Pain</rights><rights>2013 World Institute of Pain.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4002-bc4d870714a20812d95b4583cf1e5a40ab7c1495e9ad4064c142c846a1cda5103</citedby><cites>FETCH-LOGICAL-c4002-bc4d870714a20812d95b4583cf1e5a40ab7c1495e9ad4064c142c846a1cda5103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpapr.12112$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpapr.12112$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24118805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bosscher, Hemmo A.</creatorcontrib><creatorcontrib>Heavner, James E.</creatorcontrib><title>Lumbosacral Epiduroscopy Findings Predict Treatment Outcome</title><title>Pain practice</title><addtitle>Pain Pract</addtitle><description>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.
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.
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.
Main Outcome Measures
Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios.
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 < 0.01).
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 > 0.1).
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Chronic Pain - diagnosis</subject><subject>Chronic Pain - pathology</subject><subject>Chronic Pain - physiopathology</subject><subject>Chronic Pain - therapy</subject><subject>Dura Mater - blood supply</subject><subject>Dura Mater - pathology</subject><subject>Endoscopy - instrumentation</subject><subject>Epidural Space - blood supply</subject><subject>Epidural Space - pathology</subject><subject>Female</subject><subject>fibrosis</subject><subject>Fluoroscopy</subject><subject>Humans</subject><subject>inflammation</subject><subject>Leg - physiopathology</subject><subject>low back pain</subject><subject>Low Back Pain - diagnosis</subject><subject>Low Back Pain - pathology</subject><subject>Low Back Pain - physiopathology</subject><subject>Low Back Pain - therapy</subject><subject>lumbosacral epiduroscopy</subject><subject>Lumbosacral Region</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurologic Examination</subject><subject>outcome prediction</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>radiating pain</subject><subject>Sensitivity and Specificity</subject><subject>Treatment Outcome</subject><subject>vascularity</subject><subject>Young Adult</subject><issn>1530-7085</issn><issn>1533-2500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PwkAQhjdGI4he_AGmR2NS3NmPdhtPhACaECAEw3Gz3S6m2tK620b59xYKHJ3LzCTPvMk8CN0D7kNTz6UqbR8IALlAXeCU-oRjfHmYsR9iwTvoxrlPjCGMKL1GHcIAhMC8i16mdR4XTmmrMm9UpkltC6eLcueN022Sbj-ct7AmSXXlraxRVW62lTevK13k5hZdbVTmzN2x99D7eLQavvrT-eRtOJj6mmFM_FizRIQ4BKYIFkCSiMeMC6o3YLhiWMWhBhZxE6mE4YA1C9GCBQp0ojhg2kOPbW5pi-_auErmqdMmy9TWFLWTwBklggdAGvSpRXXzhrNmI0ub5sruJGC5lyX3suRBVgM_HHPrODfJGT3ZaQBogZ80M7t_ouRisFieQv32JnWV-T3fKPslg5CGXK5nExnMoqWI-FoS-gflRYI6</recordid><startdate>201407</startdate><enddate>201407</enddate><creator>Bosscher, Hemmo A.</creator><creator>Heavner, James E.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201407</creationdate><title>Lumbosacral Epiduroscopy Findings Predict Treatment Outcome</title><author>Bosscher, Hemmo A. ; Heavner, James E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4002-bc4d870714a20812d95b4583cf1e5a40ab7c1495e9ad4064c142c846a1cda5103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Chronic Pain - diagnosis</topic><topic>Chronic Pain - pathology</topic><topic>Chronic Pain - physiopathology</topic><topic>Chronic Pain - therapy</topic><topic>Dura Mater - blood supply</topic><topic>Dura Mater - pathology</topic><topic>Endoscopy - instrumentation</topic><topic>Epidural Space - blood supply</topic><topic>Epidural Space - pathology</topic><topic>Female</topic><topic>fibrosis</topic><topic>Fluoroscopy</topic><topic>Humans</topic><topic>inflammation</topic><topic>Leg - physiopathology</topic><topic>low back pain</topic><topic>Low Back Pain - diagnosis</topic><topic>Low Back Pain - pathology</topic><topic>Low Back Pain - physiopathology</topic><topic>Low Back Pain - therapy</topic><topic>lumbosacral epiduroscopy</topic><topic>Lumbosacral Region</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurologic Examination</topic><topic>outcome prediction</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>radiating pain</topic><topic>Sensitivity and Specificity</topic><topic>Treatment Outcome</topic><topic>vascularity</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bosscher, Hemmo A.</creatorcontrib><creatorcontrib>Heavner, James E.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pain practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bosscher, Hemmo A.</au><au>Heavner, James E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lumbosacral Epiduroscopy Findings Predict Treatment Outcome</atitle><jtitle>Pain practice</jtitle><addtitle>Pain Pract</addtitle><date>2014-07</date><risdate>2014</risdate><volume>14</volume><issue>6</issue><spage>506</spage><epage>514</epage><pages>506-514</pages><issn>1530-7085</issn><eissn>1533-2500</eissn><abstract>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.
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.
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.
Main Outcome Measures
Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios.
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 < 0.01).
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 > 0.1).
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.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24118805</pmid><doi>10.1111/papr.12112</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Chronic Pain - diagnosis Chronic Pain - pathology Chronic Pain - physiopathology Chronic Pain - therapy Dura Mater - blood supply Dura Mater - pathology Endoscopy - instrumentation Epidural Space - blood supply Epidural Space - pathology Female fibrosis Fluoroscopy Humans inflammation Leg - physiopathology low back pain Low Back Pain - diagnosis Low Back Pain - pathology Low Back Pain - physiopathology Low Back Pain - therapy lumbosacral epiduroscopy Lumbosacral Region Male Middle Aged Neurologic Examination outcome prediction Prognosis Prospective Studies radiating pain Sensitivity and Specificity Treatment Outcome vascularity Young Adult |
| title | Lumbosacral Epiduroscopy Findings Predict Treatment Outcome |
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