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Kim CS, Moon YJ, Kim JW, Hyun DM, Son SL, Shin JW, Kim DH, Choi SS, Karm MH. Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations. J Clin Med 2020; 9:jcm9040981. [PMID: 32244742 PMCID: PMC7230206 DOI: 10.3390/jcm9040981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here.
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Affiliation(s)
- Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Yeon-Jin Moon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Korea; (Y.-J.M.); (S.L.S.)
| | - Jae Won Kim
- Department of Anesthesiology and Pain Medicine, Eulji University Medical Center, Eulji University College of Medicine, Daejeon 35233, Korea;
| | - Dong-Min Hyun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Shill Lee Son
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Korea; (Y.-J.M.); (S.L.S.)
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-S.K.); (D.-M.H.); (J.-W.S.); (D.-H.K.)
- Correspondence: (S.-S.C.); (M.-H.K.); Tel.: +82-2-3010-1538 (S.-S.C.); +82-2-2072-3847 (M.-H.K.)
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul 03080, Korea
- Correspondence: (S.-S.C.); (M.-H.K.); Tel.: +82-2-3010-1538 (S.-S.C.); +82-2-2072-3847 (M.-H.K.)
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Gil HY, Jeong S, Cho H, Choi E, Nahm FS, Lee PB. Kambin's Triangle Approach versus Traditional Safe Triangle Approach for Percutaneous Transforaminal Epidural Adhesiolysis Using an Inflatable Balloon Catheter: A Pilot Study. J Clin Med 2019; 8:jcm8111996. [PMID: 31731783 PMCID: PMC6912526 DOI: 10.3390/jcm8111996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/25/2022] Open
Abstract
Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter can reduce the patients’ pain and improve their functional capacity. We aimed to evaluate the safety and efficacy of the Kambin’s-triangle approach for PTFA using an inflatable balloon catheter and compare this approach to the traditional safe-triangle approach. Thirty patients with chronic unilateral L5 radiculopathy were divided into two groups: the safe-triangle-approach and Kambin’s-triangle-approach groups, with 15 patients each. The success rate of the procedure was assessed. Pain and dysfunction were assessed using the Numerical Rating Scale and Oswestry Disability Index, respectively, before the procedure and at 1 and 3 months after the procedure. The success rate of the procedure was high in both the groups, with no significant difference between the groups. The Numerical Rating Scale and Oswestry Disability Index scores significantly decreased 3 months after the procedure in both the groups, with no significant difference between the groups. For patients in whom the safe-triangle approach for PTFA is difficult, the Kambin’s-triangle approach could be an alternative.
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Affiliation(s)
- Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Ajou University College of Medicine, Suwon 16499, Korea;
| | - Sangmin Jeong
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Hyunwook Cho
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Multidisciplinary Pain Center, Seoul National University Bundang Hospital, Seongnam 13496, Korea; (S.J.); (H.C.); (E.C.); (F.S.N.)
- Correspondence: ; Tel.: +82-31-787-7499
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Park JY, Ji GY, Lee SW, Park JK, Ha D, Park Y, Cho SS, Moon SH, Shin JW, Kim DJ, Shin DA, Choi SS. Relationship of Success Rate for Balloon Adhesiolysis with Clinical Outcomes in Chronic Intractable Lumbar Radicular Pain: A Multicenter Prospective Study. J Clin Med 2019; 8:E606. [PMID: 31058860 PMCID: PMC6572522 DOI: 10.3390/jcm8050606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/28/2019] [Indexed: 12/29/2022] Open
Abstract
Combined balloon decompression and epidural adhesiolysis has been reported to be effective in refractory lumbar spinal stenosis. Many cases of intractable stenosis have symptom-related multiple target sites for interventional treatment. In this situation it may not be possible to perform balloon adhesiolysis, or even only epidural adhesiolysis, for all target sites. Therefore, this multicenter prospective observational study aimed to evaluate the relationship of successful ballooning rate for multiple target sites with clinical outcome. Based on the ballooning success rate of multiple target sites, the patients were divided into three groups: below 50%, 50-85%, and above 85% ballooning. A greater ballooning success rate for multiple target sites provided a more decreased pain intensity and improved functional status in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 6 months. The estimated proportions of successful responders according to a multidimensional approach in the below 50%, 50-85%, and above 85% balloon success groups at 6 months after the procedure were 0.292, 0.468, and 0.507, respectively (p = 0.038). Our study suggests the more successful balloon adhesiolysis procedures for multiple target lesions are performed, the better clinical outcome can be expected at least 6 months after treatment.
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Affiliation(s)
- Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Gyu Yeul Ji
- Department of Neurosurgery, Spine and Joint Research Institute, Guro Cham Teun Teun Hospital, Seoul 08392, Korea.
| | - Sang Won Lee
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Jin Kyu Park
- Department of Neurosurgery, Himchan Hospital, Bupyeong 21399, Korea.
| | - Dongwon Ha
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Youngmok Park
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan 49201, Korea.
| | - Sang Ho Moon
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul 02488, Korea.
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
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Choi SS, Lee JH, Kim D, Kim HK, Lee S, Song KJ, Park JK, Shim JH. Effectiveness and Factors Associated with Epidural Decompression and Adhesiolysis Using a Balloon-Inflatable Catheter in Chronic Lumbar Spinal Stenosis: 1-Year Follow-Up. PAIN MEDICINE 2015; 17:476-487. [PMID: 26814254 DOI: 10.1093/pm/pnv018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/20/2015] [Accepted: 09/05/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to investigate the efficacy of the combined balloon decompression with a balloon-inflatable catheter (ZiNeu) in addition to conventional epidural adhesiolysis, and to identify factors that predict patient responses. STUDY DESIGN An institutional single-armed prospective observational study. SUBJECTS Chronic refractory lumbar spinal stenosis. METHODS This study was performed in 61 patients with spinal stenosis who suffered from chronic (at least 3 months) lumbar radicular pain with or without lower back pain. Patients had failed to maintain improvement for more than 1 month with conventional epidural injection. The numeric rating scale (NRS) and Oswestry disability index (ODI) were each measured at 1, 3, 6, and 12 months after percutaneous epidural adhesiolysis and balloon decompression with a ZiNeu catheter. RESULTS The percentage of successful responders was 72.1%, 60.7%, 57.4%, and 36.1% of patients at 1, 3, 6, and 12 months, respectively. A single combined treatment of percutaneous epidural adhesiolysis and balloon decompression with a ZiNeu catheter provided sufficient pain relief and functional improvement in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 12 months (P < 0.001). Multivariate logistic regression analysis showed that absence of diabetes independently predicted successful response at 12 months after percutaneous epidural decompression and adhesiolysis with the balloon catheter (Odds ratio = 0.080; 95% confidence interval = 0.009-0.676; P = 0.020). CONCLUSIONS The combined epidural adhesiolysis and balloon decompression with a ZiNeu catheter led to significant pain relief and functional improvement in a subset of patients with refractory spinal stenosis.
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Affiliation(s)
- Seong-Soo Choi
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul;
| | - Jong-Hyuk Lee
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Doohwan Kim
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyun Kyu Kim
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sohee Lee
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Kyo Joon Song
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul
| | - Jin Kyu Park
- Department of Neurosurgery, Himchan Hospital, Incheon
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, School of Medicine, Hanyang University, Guri-si, Republic of Korea
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