Cerrahi açıdan kontrendike olan şiddetli lomber spinal stenoz hastalarında non-operatif bir tedavi seçeneği: kaudal pulsed radyofrekans sonuçları

Abstract

Giriş/Amaç: Şiddetli lomber spinal stenoz (LSS) olgularında cerrahi dekompresyon standart tedavi yöntemi olarak kabul edilmektedir. Ancak ileri yaş, ciddi komorbiditeler ve belirgin kanal darlığı nedeniyle birçok hasta cerrahi veya yüksek hacimli epidural steroid enjeksiyonları için uygun değildir. Kaudal epidural pulsed radyofrekans (PRF), bu klinik olarak zorlu hasta grubunda minimal invaziv bir alternatif sağlayabilir. Bu çalışmanın amacı; cerrahi ve epidural steroid enjeksiyonu açısından kontrendike olan şiddetli LSS hastalarında kaudal epidural PRF’nin klinik etkinlik ve güvenilirliğini değerlendirmektir. Gereç ve Yöntem: Bu retrospektif, tek merkezli çalışma; manyetik rezonans görüntüleme ile doğrulanmış ve dural kese kesitsel alanı <50 mm² olan 32 şiddetli LSS hastasını içermektedir. Tüm hastalara epidural kortikosteroid veya lokal anestezik enjekte edilmeden kaudal epidural PRF uygulandı. Ağrı şiddeti (VAS), fonksiyonel yeti kaybı (ODI), yürüme kapasitesi (6DYT), sağlıkla ilişkili yaşam kalitesi (EQ-VAS) ve analjezik kullanımı işlem öncesi ve 1., 3. ve 6. aylarda değerlendirildi. Radyolojik şiddet, iki kör gözlemci tarafından yeniden değerlendirildi ve gözlemciler arası uyum intraklas korelasyon katsayısı ile analiz edildi. Bulgular: Altıncı ayda tüm klinik sonuçlarda anlamlı ve klinik olarak belirgin iyileşmeler gözlendi. Ortalama ODI, 34.56 ± 2.29’dan 26.56 ± 3.02’ye (p < 0.001); 6DYT mesafesi 136.2 ± 20.3 metreden 216.9 ± 22.2 metreye yükseldi (p < 0.001). Ortalama VAS skoru 8.81 ± 1.06’dan 6.34 ± 1.02’ye geriledi (p < 0.001) ve hastaların %46.9’unda ≥%30 ağrı azalması sağlandı. EQ-VAS skoru 21.7 puan arttı (p < 0.001). Günlük tramadol ve asemetasin kullanımı %50’den fazla azaldı (p < 0.001). İşleme bağlı herhangi bir komplikasyon görülmedi. Radyolojik değerlendirmede gözlemciler arası uyum mükemmel düzeydeydi (ICC = 0.91; %95 GA: 0.87–0.96). Sonuç: Kaudal epidural PRF, cerrahi dekompresyona uygun olmayan şiddetli LSS hastalarında güvenli ve klinik olarak faydalı bir non-operatif tedavi seçeneği sunmaktadır. Ağrı kontrolü, mobilite ve genel sağlık algısındaki iyileşmeler ile azalan analjezik ihtiyacı, PRF’nin multidisipliner omurga tedavi yaklaşımlarında değerli bir tamamlayıcı yöntem olabileceğini göstermektedir. Sonuçların doğrulanması için daha geniş örneklemli prospektif kontrollü çalışmalara ihtiyaç vardır.

Keywords

• Lomber Spinal Stenoz
• Kaudal Epidural
• Pulsed Radyofrekans
• Non-Operatif Tedavi
• Fonksiyonel Sonuçlar
• Yaşam Kalitesi

A non-operative treatment option for severe lumbar spinal stenosis in patients medically contraindicated for surgery: caudal pulsed radiofrequency outcomes

Abstract

Aims: Surgical decompression is considered the standard treatment for severe lumbar spinal stenosis (LSS). However, many elderly patients are deemed unsuitable for surgery or high-volume epidural steroid injections due to extensive canal narrowing and significant comorbidity burden. Caudal epidural pulsed radiofrequency (PRF) may serve as a minimally invasive alternative in this clinically challenging subgroup. This study aimed to evaluate the clinical efficacy and safety of caudal epidural PRF in patients with severe LSS who are contraindicated for surgery and epidural steroid injection. Methods: This retrospective single-center study included 32 patients with MRI-confirmed severe LSS (dural sac cross-sectional area <50 mm²) who were contraindicated for decompression surgery and epidural steroid injection. All patients underwent caudal epidural PRF without epidural corticosteroid or local anesthetic injectates. Pain intensity (VAS), functional disability (ODI), ambulatory capacity (6MWT), health-related quality of life (EQ-VAS), and analgesic consumption were assessed at baseline and at 1, 3, and 6 months post-procedure. Radiological severity was evaluated using dural sac cross-sectional area and Schizas grading, re-assessed retrospectively by two independent blinded observers. Interobserver reliability was examined using intraclass correlation coefficients. Results: At six months, clinically meaningful improvements were observed across all outcomes. Mean ODI decreased from 34.56±2.29 to 26.56±3.02 (p<0.001), and mean 6MWT distance increased from 136.2±20.3 m to 216.9±22.2 m (p<0.001), demonstrating enhanced ambulatory function and reduced disability. Mean VAS decreased from 8.81±1.06 to 6.34±1.02 (p<0.001), with 46.9% of patients achieving a≥30% reduction in pain. EQ-VAS improved by 21.7 points (p<0.001), and daily tramadol and acemetacin intake declined by more than 50% (p<0.001 for both). No procedural complications occurred. Interobserver reliability for MRI-based severity assessment was excellent (ICC=0.91; 95% CI: 0.87-0.96). Conclusion: Caudal epidural PRF appears to be a safe and clinically beneficial non-operative strategy for patients with severe LSS who are not eligible for surgical decompression. Improvements in pain, mobility, and overall health perception, together with reduced analgesic dependence, support PRF as a valuable adjunct in multidisciplinary spine care. However, these findings should be interpreted with caution given the retrospective design and relatively small sample size of the study. Prospective controlled studies are needed to further validate these findings.

Keywords

• Lumbar spinal stenosis
• caudal epidural
• pulsed radiofrequency
• nonoperative management
• functional outcomes
• quality of life

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