Abstract
Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from epidural steroid injection or even epidural neuroplasty with a balloon-less catheter. However, exact indications or predictive factors for epidural balloon neuroplasty have not been fully evaluated. Therefore, to assess associated factors that could affect a favorable outcome, we analyzed a prospectively collected multicenter cohort of patients with chronic refractory lumbar foraminal stenosis after balloon neuroplasty. At the 6-month point in follow-up, 92 (44.4%) patients among 207 subjects were classified as successful responders according to a robust combination of outcome measures. Multivariate logistic regression analysis also showed that mild grade lumbar foraminal stenosis may be an independent factor associated with a successful response 6 months after balloon neuroplasty (odds ratio = 2.829; 95% confidence interval = 1.351–5.923; p = 0.006). However, we found that there were 29.4% and 24.6% successful responders with moderate and severe foraminal stenosis, respectively. Attempting balloon neuroplasty in refractory lumbar foraminal stenosis, especially mild grade, may be worthwhile.
Highlights
Epidural steroid injections are suggested to provide short-term symptom relief in patients with lumbar radiculopathy or neurogenic claudication, but benefits are not seen in all patients or are still inconsistent [1,2]
Previous studies have showed that spondylolisthesis, previous lumbar spinal surgery, and foraminal stenosis may be associated with outcomes after percutaneous epidural adhesiolysis with a balloon-less catheter [3], preprocedural patient factors associated with positive outcomes after percutaneous neuroplasty have not been clearly investigated
Kim et al found that lumbar foraminal stenosis caused primarily by degenerative disc herniation may be an independent factor for favorable outcome after transforaminal balloon neuroplasty [9]
Summary
Epidural steroid injections are suggested to provide short-term symptom relief in patients with lumbar radiculopathy or neurogenic claudication, but benefits are not seen in all patients or are still inconsistent [1,2]. In these refractory cases, epidural neuroplasty, often called percutaneous epidural adhesiolysis, is currently performed using a shear-resistant catheter (the Racz-type catheter) or with a more steerable navigation catheter [3,4]. Choi et al found that co-existing lower back pain and possible neuropathic conditions such as diabetes mellitus may be independent factors of poor outcome from decompressive adhesiolysis and neuroplasty with an inflatable balloon catheter in patients with lumbar radicular pain [10]
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