🔬 Scientific Evidence for the Effectiveness of PEN Procedure

 

🔬 Scientific Evidence for the Effectiveness of PEN Procedure

1. Effectiveness in Chronic Low Back Pain and Radicular Leg Pain

Percutaneous Epidural Neuroplasty (PEN) has been recognized as an effective treatment for patients suffering from chronic low back pain and radicular leg pain. In particular, for patients with single-level lumbar disc herniation (LDH), PEN has shown positive outcomes in relieving pain and improving function. These effects have been reported to last up to one year post-procedure, and some studies indicate long-term benefits lasting up to ten years. (painphysicianjournal.com)

2. Application in Lumbar Spinal Stenosis (LSS)

PEN can also provide significant pain relief and functional improvement in patients with lumbar spinal stenosis. Especially in cases with epidural adhesions, the procedure helps by removing adhesions and delivering medication directly to the affected area. However, its effectiveness may vary depending on the degree of stenosis and the patient’s anatomical structure.

3. Safety and Side Effects

PEN is considered a relatively safe, minimally invasive procedure with a low incidence of major complications. Nonetheless, rare side effects such as catheter damage, infection, or bleeding can occur, and the procedure should only be performed by trained and experienced medical professionals. (en.wikipedia.org)

🧬 Mechanism of PEN Procedure

PEN is a non-surgical treatment designed to relieve pain caused by adhesions or inflammation in the epidural space of the spinal canal. It uses a specialized catheter to mechanically break down scar tissue and deliver anti-inflammatory medication directly to the affected site, thereby reducing pain.

🩺 Procedure Steps

  • Patient Preparation: The patient lies in the prone position, and the area is disinfected to maintain a sterile environment.

  • Local Anesthesia: A local anesthetic is injected to minimize pain during the procedure. (scholarworks.bwise.kr)

  • Catheter Insertion: Using C-arm fluoroscopic guidance, a specialized catheter (1–1.5 mm in diameter) is inserted into the epidural space through the sacral hiatus. (pssh.kr)

  • Contrast Injection & Positioning: A contrast agent is injected to verify the position of the catheter and accurately locate the affected area. (youstore.tistory.com)

  • Medication Injection: A combination of hyaluronidase (to break down adhesions), local anesthetics (e.g., lidocaine, ropivacaine), and steroids (e.g., dexamethasone) is injected to reduce inflammation and pain. (youstore.tistory.com)

  • Catheter Removal & Dressing: After medication delivery, the catheter is removed, bleeding is controlled, and the site is dressed.

⏱️ Procedure Duration & Recovery

  • Duration: Approximately 20–30 minutes

  • Recovery: Patients can usually resume daily activities after 1–2 hours of rest post-procedure. (blog.naver.com)

⚠️ Post-Procedure Precautions

  • Care: Keep the injection site clean and avoid excessive physical activity.

  • Complications: Rare complications such as infection, bleeding, or nerve damage may occur. Any unusual symptoms should be immediately reported to the medical team.

✅ Conclusion

PEN is an effective treatment option for patients with chronic low back or radicular pain that does not respond to conservative treatment. It is especially beneficial for cases involving single-level lumbar disc herniation or lumbar spinal stenosis with epidural adhesions. However, patient-specific factors and anatomical conditions must be considered to determine suitability. The procedure should be carried out by experienced specialists.

References:

  • Manchikanti L, et al. “Long-term Efficacy of Percutaneous Epidural Neurolysis of Adhesions in Chronic Lumbar Radicular Pain.” Pain Physician. 2017;20(5). [painphysicianjournal.com]

  • Kim JH, et al. “Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single-Level Lumbar Disc Herniation.” Yonsei Med J. 2015;56(3):691-697. [eymj.org]

  • Wikipedia contributors. "Epidural lysis of adhesions." Wikipedia, The Free Encyclopedia.





#PENProcedure  

#EpiduralNeuroplasty  

#ChronicBackPain  

#LumbarDiscHerniation  

#SpinalStenosis  

#MinimallyInvasiveTreatment  

#PainManagement  

#BackPainRelief  

#NonSurgicalPainRelief  

#EpiduralAdhesions  

#Neurolysis  

#SpineHealth  

#InterventionalPainMedicine  

#CatheterBasedTherapy  

#PENClinicalEvidence

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