Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis: A retrospective analysis and technical considerations.

Abstract

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.