Contrast runoff correlates with the clinical outcome of cervical epidural neuroplasty using a racz catheter

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. © 2016,american society of interventional pain physicians. all rights reserved.