Transsacral Canal Plasty for Decompression of Lumbar Spinal Stenosis in a Patient With Epidural Lipomatosis

Abstract

Case: A 58-year-old man presented with lumbar spinal stenosis due to epidural lipomatosis. He underwent transsacral canal plasty (TSCP), in a manner similar to epidural adhesiolysis, which can be performed under local anesthesia. His leg pain improved dramatically in the year after surgery. Furthermore, magnetic resonance images during this time show neural decompression by reduction of the amount of epidural fat.Conclusion: TSCP was found not only to relieve pain but also to achieve neural decompression in this patient with spinal canal stenosis caused by lumbar epidural lipomatosis. This is the first report to demonstrate the usefulness of TSCP for spinal epidural lipomatosis.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/ B975).

Factors leading to open revision surgery after trans-sacral canal plasty for lumbar spine disease

“…Unlike conventional catheters such as the Racz, the catheter used for TSCP (myeloCath®, Biomedica Healthcare Ltd., Tokyo, Japan) ( 8 ) is movable with excellent operability and followability, and mechanical adhesiolysis is possible by simply moving it from side to side ( 13 ). Data from collaborative studies at other institutions have shown that TSCP improves back and leg pain regardless of whether the patient has had previous spine surgery and that it may be a treatment option for elderly and immunocompromised patients for whom multiple surgeries are not recommended ( 8 ).…”

“…Consistent with this, there are previous reports indicating that dural sac area is a more sensitive measurement parameter than spinal canal area ( 31 ) and that a narrow dural sac area on magnetic resonance images is associated with leg pain at 1 year after lumbar spine surgery ( 32 ). Further, in view of a report suggesting that stenosis caused by epidural lipomatosis can be relieved by dissection of adhesions ( 13 ), the presence or absence of epidural lipomatosis was also selected as a factor. Other limitations of this study are that not all factors were included in the multivariate analysis and collinearity between factors could not be considered.…”

“…Comorbidities were scored using the Elixhauser Comorbidity Index (ECI) ( 15 – 17 ). Preoperative imaging parameters were investigated, including the lesion level (L4/5, L5/S1, other), presence of intervertebral instability [change of more than 4 mm anteriorly or 2 mm posteriorly on dynamic radiographs ( 14 )], dural sac area (mm 2 , calculated using ImageJ software [National Institutes of Health, Bethesda, MD] ( 13 )), presence of bony stenosis (bony prominence protruding more than 5 mm towards the dural sac) and presence of epidural lipoma (ventral side of the dural canal, determined to be the cause of the stenosis). For the dural sac area, we selected the higher-intensity area that we considered the most significant cause of symptoms in each patient.…”

“…Trans-sacral canal plasty (TSCP) is one of the methods that can be used for epidural lysis of adhesions and was recently described by the Intraspinal Canal Treatment (ISCT) Study Group, which is a subcommittee of the Minimally Invasive Spinal Treatment Society ( 8 , 13 ). TSCP can be performed under local anaesthesia using a trans-sacral approach with a 2.65-mm disposable steerable catheter.…”

“…TSCP has been reported to be effective whether or not there is a history of previous spine surgery ( 8 ). At our hospital, TSCP has become the first-line treatment for patients with lumbar spine conditions that do not respond to conservative treatment, such as lumbar spinal stenosis and lumbar disc herniation ( 13 ). However, more than a few patients experience pain flares after TSCP and require further spine surgery.…”