Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis

Kim, Sung Hoon; Koh, Won Uk; Park, Soo‐Jin; Choi, Woo-Young; Suh, Jeong Hun; Leem, Jeong Gil; Park, Pyung Hwan; Shin, Jin Woo

doi:10.3344/kjp.2012.25.1.55

Cited by 12 publications

(13 citation statements)

References 19 publications

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“…Our institute previously published several articles about nonsurgical interventions, [ 1 – 4 ] particularly balloon decompression and adhesiolysis of the lumbar epidural space and neural foramen in patients with lumbar spinal stenosis. [ 1 , 2 ] Transforaminal epidural steroid injection was proven to be effective in patients with foraminal stenosis.…”

Section: Introductionmentioning

confidence: 99%

Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis

Seo

Lee

et al. 2018

Medicine

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A previous study showed that transforaminal balloon adhesiolysis via the safe triangle was effective in lumbar spinal stenosis. However, retrodiscal pathology is difficult to treat with this method. Therefore we attempted retrodiscal balloon adhesiolysis via Kambin's triangle. The design of our study is a retrospective analysis. The setting of our study is a tertiary, interventional pain management practice, speciality referral center.The primary indication for this procedure is radicular pain arising from ipsilateral retrodiscal pathology. Medical records were reviewed of patients who received retrodiscal decompression with a transforaminal balloon inflatable catheter between January 1, 2016 and July 31, 2017. The intervention was conducted by 2 well-trained pain specialists. The introducer needle was positioned at Kambin's triangle. Adhesiolysis was performed using a balloon filled with radiocontrast media. After balloon adhesiolysis, an agent containing lidocaine and dexamethasone was injected through the introducer sheath. Numeric rating scale pain scores were obtained 1 and 3 months after the procedure.The mean pre-procedure numeric rating scale score was 7.05 ± 1.40. After 1 and 3 months, the mean scores were 3.91 ± 2.20 and 3.77 ± 2.11, respectively. No patient had significant complications. Also, technical considerations were discussed.Chronic pain due to lumbar central stenosis, especially ipsilateral retrodiscal pathology, can be reduced by retrodiscal balloon adhesiolysis through Kambin's triangle. Although this study is limited by its retrospective design, the results suggest that this procedure is a useful treatment due to its ease of performance and cost-effectiveness.

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Section: Introductionmentioning

confidence: 99%

Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis

Seo

Lee

et al. 2018

Medicine

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“…Thus, our present results may be limited. Future studies should examine the correlation between the IAPCSA and conventional quantitative radiological criteria for CLSS [26][27][28][29][30][31][32][33][34][35][36][37]. In spite of these limitations, this is the first study to document the association of IAPCSA with CLSS.…”

Section: Discussionmentioning

confidence: 92%

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Lee

Lim

et al. 2020

JCM

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Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm2 in control subjects and 88.77 ± 18.52 mm2 in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm2, with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS.

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“…Since it was first described in patients with failed back surgery syndrome, percutaneous adhesiolysis has been used to lyse epidural scars [ 7 ], and treat radicular pain in various diseases [ 13 , 14 ]. Conventional epidural adhesiolysis was performed via a caudal approach, and combinations of the following three methods are purportedly used: 1) volumetric: injection of a large volume of normal saline [ 7 , 14 ], 2) mechanical: the use of a specially designed catheter [ 14 , 15 , 16 ], and 3) chemical: the use of hypertonic saline and hyaluronidase [ 13 , 17 , 18 ]. Of these methods, we focused on volumetric adhesiolysis because it can be easily incorporated into a transforaminal approach without additional instrumentation or an increased risk of adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

“…For conventional epidural adhesiolysis, high-volume irrigation (60-80 ml of fluid) is typically performed via a caudal approach with or without catheterization [ 5 , 8 ]. There are few reports about transforaminal epidural adhesiolysis [ 13 , 16 , 18 ], and no study is available on a volumetric method alone. A higher volume of saline irrigation would be necessary for a more effective transforaminal approach, and conscious sedation with hypnotics and analgesics may be helpful considering severe paresthesias or radiating pain during a forceful injection.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

et al. 2014

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BackgroundLumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids.MethodsFifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up.ResultsThere were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117).ConclusionsA forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.

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Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis

Cited by 12 publications

References 19 publications

Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis

Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

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