Treating radiculopathy with an indwelling epidural catheter and infusion pump

For the purpose of reducing inflammation causing radiculopathy, lumbar transforaminal and interlaminar epidural injections deliver corticosteroid to the vicinity of the spinal nerve, nerve roots, and intervertebral disc. Although acceptable, the efficacy of transforaminal injections is limited and variable. An indwelling epidural catheter offers the distinct advantages of delivering greater concentrations of corticosteroid directly to the site of pathology, over an extended duration. This extended exposure to corticosteroid may benefit the site of pathology.

To evaluate the safety and efficacy of corticosteroid administered through a disposable indwelling epidural catheter and infusion pump to treat pain and dysfunction caused by lumbosacral radiculopathy.

A pilot investigation consisting of a prospective consecutive series of 10 patients, conducted in a specialty hospital.

An indwelling epidural catheter dispensed corticosteroid into the epidural space at the suspect level of pathology. The catheter was attached to an external, lightweight, spring-pressurized, and disposable reservoir pump holding 8.0 mg dexamethasone diluted with bacteriostatic normal saline to a total volume of 72 ml. After each patient's hospital discharge, the medication was administered into the epidural space at a rate of 1 ml per hour over a 72-hour period. Follow-up at six weeks was achieved in 100% of the patients.

The outcome measures, recorded at pre-treatment and six weeks post-treatment were assessed using: the Visual Analog Scale (VAS); MOS 36-Item Short-Form Health Survey (SF-36); Pain Symptoms Survey; Oswestry Disability Index; Beck Inventory; Work History Survey; Work Index; Expectations Met Survey; Activities of Daily Living Form; and the Satisfaction With Treatment Form.

There was no patient morbidity or mortality associated with this treatment, and patients, on average, experienced decreased pain levels after treatment. Mean delta VAS improvement was 4.1 (SD = 2.6, R =-9.6 to +1.5). The mean percent improvement was 46.7%.

Safe and effective treatment of lower extremity radiculopathy symptoms may be obtained with this new method.