BY: Winston C.V. Parris, M.D., Ira Fox, M.D., Debbie Areford, R.N., Sheila Carver, R.N., Dan Thomas, M.D.
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
Many patients with chronic low back pain secondary to spinal stenosis (SS) and Failed Back Surgery Syndrome (FBSS) do not respond to conventional pain modalities (eg., Epidural Steroid Injections and Lumbar Facet Injections. Percutaneous Neuroplasty (PN) with 10% Hypertonic Saline (HS) appears to be useful in managing pain in that patient population. The mechanism of action is not precisely known. It is proposed that HS may decrease neuronal swelling via osmotically-induced fluid shift, resulting in decreased pressure on nerves; HS may have a local anesthetic on intact dorsal rootlets; C-Fiber blockade secondary to the chloride effect of HS and possible to a diuretic on epidural scar tissue. A retrospective analysis of patients with intractable low back pain associated with SS and FBSS and who were treated with PN using 10% HS was performed for efficacy and safety.