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KMID : 1037020140030020075
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Medical Lasers; Engineering, Basic Research, and Clinical Application
2014 Volume.3 No. 2 p.75 ~ p.83
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Intra-Annular Granulation Tissue Syndrome: Clinico-Histological Study of High Intensity Zones and the Role of Percutaneous Endoscopic Lumbar Annuloplasty as Therapy with Two Years Follow-up
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Lee Sang-Ho
Kumar Ramakant
Bae Jun-Seok
Sabal Luigi Andrew
Park Seung-Suk
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Abstract
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Background and Objectives: Chronic back pain has been associated with high intensity zones (HIZs) on MRI. Our objectives are to study: any correlation between HIZs on MRI and presence of granulation tissue; symptoms in patients with HIZ; therapeutic efficacy of percutaneous endoscopic lumbar annuloplasty (PELAN) in such patients.
Materials and Methods: A retrospective study was conducted in a single institution where PELAN was performed from 2009 to 2011. All patients underwent thorough physical and radiologic evaluation. Posterior sub-annular tissue biopsy was performed intra-operatively. Clinical and functional outcome were assessed using visual analogue score (VAS), Owestry disability score (ODI), and modified Mcnab criteria. Patients were followed-up at one month, six months, one year, and two years.
Results: A total of 24 patients were included. The mean age of the study population was 47.29. Mean and minimum follow-up periods were 29 and 24 months, respectively. All patients were questioned about their symptoms. All patients complained of sitting intolerance and dramatic relief after unloading. None had neurological deficits. Mean pre-op VAS score was 7.5, significantly improving to 2.5 at 2-year follow-up, while ODI was 69.1, significantly improving to 29; 62.5% (15 patients) had excellent functional outcome, while good and fair outcomes were reported by 25% and 12.5 % patients, respectively. Out of 24 biopsy samples, 19 patients (79.17%) patients had positive granulation tissue findings.
Conclusion: HIZ represents granulation tissue, which may or may not be the cause of low back pain. PELAN can be a treatment modality for intra-annular granulation syndrome.
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KEYWORD
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Intra-annular granulation tissue syndrome, High intensity zone, Percutaneous endoscopic lumbar annuloplasty
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