Effectiveness and Factors Associated with Epidural Decompression and Adhesiolysis Using a Balloon-Inflatable Catheter in Chronic Lumbar Spinal Stenosis: 1-Year Follow-Up

Abstract

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.

Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations

“…Epidural adhesion can play a key role in the development of chronic lumbar radicular pain and/or LBP [5,6,18], and percutaneous epidural adhesiolysis is an effective way to alleviate the symptoms of these patients, particularly those who do not respond well to conventional epidural blocks [1,3,10,19]. As one of the methods of percutaneous epidural adhesiolysis, transforaminal balloon procedures can provide significant pain relief and functional improvement in patients with chronic intractable lumbar foraminal stenosis [11,13].…”

“…As one of the methods of percutaneous epidural adhesiolysis, transforaminal balloon procedures can provide significant pain relief and functional improvement in patients with chronic intractable lumbar foraminal stenosis [11,13]. Distension of the epidural space by intermittent ballooning can lead to more effective mechanical detachment of perineural adhesion and achieve more efficient delivery of epidural injected drugs to the foraminal stenotic regions by increasing the marginal space of the stenotic area [10][11][12]. In Korea, the previously reported balloon-inflatable catheter (ZiNeu ® , JUVENUI, Seoul, Korea) is commonly used for percutaneous epidural adhesiolysis via a caudal approach [9,10,12].…”

“…Distension of the epidural space by intermittent ballooning can lead to more effective mechanical detachment of perineural adhesion and achieve more efficient delivery of epidural injected drugs to the foraminal stenotic regions by increasing the marginal space of the stenotic area [10][11][12]. In Korea, the previously reported balloon-inflatable catheter (ZiNeu ® , JUVENUI, Seoul, Korea) is commonly used for percutaneous epidural adhesiolysis via a caudal approach [9,10,12]. However, this catheter has a relatively large diameter, which can cause severe pain when entering the stenotic intervertebral foramen via a caudal approach.…”

“…These failed cases suggest that correct diagnosis and patient selection for balloon adhesiolysis is important. Indeed, previous reports have already demonstrated that factors associated with the outcome of balloon adhesiolysis for the management of chronic lumbar foraminal stenosis may be diabetes, combined LBP with lumbar radicular pain, degree of lumbar foraminal stenosis, the number of target levels, and a degenerative herniated intervertebral disc [10,13,21,22]. When considering balloon adhesiolysis, patients with DM neuropathy, failed back surgery syndrome, or axial pain should be selected cautiously.…”

“…Such patients may have epidural adhesions, which are an important cause of lumbar radicular pain with or without LBP [5][6][7]. Therefore, percutaneous epidural adhesiolysis is often used to remove epidural adhesions [8]; alternatively, combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) of the transforaminal epidural space can result in significant pain relief and functional improvement in patients with intractable lumbar radicular pain with or without LBP [9][10][11][12][13].…”