Background: Chronic spinal pain resulting from disc herniation and degenerative spinal disorders is a major cause of disability and increased healthcare utilization worldwide. Although conservative management remains the first-line treatment, a considerable proportion of patients develop persistent symptoms that are refractory to standard therapeutic approaches.

Objective: To assess the clinical effectiveness, safety, and long-term outcomes of percutaneous Epidural Catheter Treatment (ECT) in patients with disc herniation, nerve root compression, spinal canal stenosis, postoperative pain syndrome (failed back surgery syndrome), and epidural adhesion formation, and to identify factors associated with favorable clinical outcomes. The purpose of this clinical study is to provide a logical and systematic framework for the application of epidural interventions in the management of spinal pain. These recommendations are based on the best available evidence regarding the effectiveness and safety of epidural and related interventional procedures for spinal pain, including pain arising from disc herniation, spinal stenosis, and post-surgical pain syndromes. The aim of this study was to evaluate the clinical effectiveness, safety, and long-term outcomes of percutaneous ECT in patients with disc herniation and related spinal disorders. We hypothesized that this intervention would result in significant and sustained pain reduction with a very low complication rate and reduced need for surgical intervention.

Methods: This retrospective statistical study included 1,850 patients with radiologically confirmed Cervical, Thoracic and lumbar disc herniation, nerve root compression syndromes, neuroforaminal stenosis, recess stenosis, spinal canal stenosis, Adhäsion, and Failed Back Surgery Syndrome who were treated with a percutaneous Epidural Catheter (ECT) at Spine and Neurosurgery Center with advanced pain management, Hamburg, Germany, between 2014 and 2024. Demographic characteristics, clinical presentation, imaging findings, and treatment-related variables were systematically collected. Pain intensity was evaluated using the Visual Analog Scale (VAS), while functional status was assessed using the Oswestry Disability Index (ODI). Assessments were performed at baseline and during follow-up at 1 week, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 3 years, and 5 years after the intervention. Statistical analyses were conducted using SPSS software, with statistical significance defined as p < 0.05. All procedures were performed on an outpatient basis without the need for hospital admission or overnight observation. As a preventive measure against infection, patients received standardized antibiotic prophylaxis administered twice daily for five days, starting on the evening before the procedure according to the institutional protocol. Clinical follow-up was supplemented by serial laboratory evaluations, including pre- and post-procedural measurement of C-reactive protein (CRP), to assess for potential infectious complications.

Results: A total of 200 patients were included in the study (mean age 54 years, 73% female). Significant improvement was observed following treatment. VAS pain scores decreased from 8.29 ± 1.24 to 2.62 ± 1.63, with a mean reduction of 5.67 ± 1.58 points (t(199) = 50.88, p < 0.001; Cohen’s d = 3.60). ODI scores also improved markedly, decreasing from 73.89 ± 12.19 to 20.10 ± 12.44, with a mean reduction of 53.79 ± 13.25 points (t(199) = 57.41, p < 0.001; Cohen’s d = 4.06). Only 25% of patients required surgery during follow-up. Younger age and absence of motor deficit were identified as independent predictors of successful conservative treatment. ECT resulted in a statistically significant reduction in pain intensity and a marked improvement in functional outcomes. Overall clinical improvement was observed in approximately 75–85% of patients (p < 0.001). Younger age and the absence of significant neurological deficits were independently associated with superior clinical outcomes. No clinically relevant infections or major procedure-related complications were identified during long-term follow-up.

Conclusion: Percutaneous ECT represents a safe and effective minimally invasive therapeutic option for patients with lumbar disc herniation and chronic spinal pain syndromes. The intervention has been associated with substantial and sustained pain relief, with reported pain reductions of up to 75–80%, as well as improvement in neurological symptoms and functional outcomes. In appropriately selected patients, it may also reduce the need for surgical intervention.