Percutaneous epidural balloon neuroplasty: a narrative review of current evidence

Abstract

Percutaneous epidural balloon neuroplasty (PEBN) using a balloon-inflatable catheter can be used to perform balloon decompression combined with percutaneous epidural neuroplasty (PEN), leading to significant pain relief and functional improvement in patients with spinal stenosis. Several prospective and retrospective studies have demonstrated the effectiveness of PEBN and supported its relatively long-term outcomes (at least 6 months, sustained for up to 12 months). Balloon neuroplasty appears to be superior to conventional PEN. Moreover, it has been shown to be effective in patients unresponsive to conventional PEN or in those with post lumbar surgery syndrome. In addition, balloon neuroplasty achieved successful outcomes regardless of the approach used, such as retrodiscal, transforaminal, contralateral interlaminar, or caudal. Chronic radicular pain without lower back pain, neurogenic intermittent claudication, and minimal neuropathic component were predictive factors for favorable outcomes after PEBN from a symptomatic perspective. A short duration of pain after lumbar surgery, lumbar foraminal stenosis caused primarily by degenerative disc herniation, mild foraminal stenosis, and perineural adhesion by degenerative discs were associated with successful outcomes of PEBN from pathological aspects. Ballooning ≥ 50% of the target sites and complete contrast medium dispersion after ballooning seemed to be crucial for successful outcomes from a technical perspective. In addition, PEBN was effective regardless of the accompanying redundant nerve roots or a mild degree of spondylolisthesis. Studies on balloon neuroplasty have reported occasional minor and self-limiting complications; however, no PEBN-related significant complications have been reported. Given the present evidence, balloon neuroplasty appears to be a safe and effective procedure with minimal complications for the treatment of spinal stenosis.

Analysis of the efficacy of retrodiscal approach percutaneous epidural adhesiolysis with WHIP catheter® in patients with lumbar radiculopathy: A retrospective study

“…In addition to the Racz catheter, which was the first to be developed, other options include nerve stimulation catheters (EpiStim® catheter; Sewoon Medical, Cheonan, Korea), steerable navigation catheters (NaviCath®; Myelotec, Roswell), zigzag-motion inflatable neuroplasty catheters (ZiNeu®; JUVENUI, Seongnam, Korea). [ 19 ] However, only a few comparative studies have been conducted on the effectiveness of these catheters. In a study by Karm et al, which compared the effectiveness of an inflatable balloon catheter and a non-balloon catheter when performing PEN in patients with central lumbar spinal stenosis, the balloon appeared to be superior to the non-balloon catheter.…”