Abstract
Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here.
Highlights
Chronic lumbar radicular pain can adversely affect the quality of life
Percutaneous epidural adhesiolysis is often used to remove epidural adhesions [8]; alternatively, combined epidural adhesiolysis and balloon decompression of the transforaminal epidural space can result in significant pain relief and functional improvement in patients with intractable lumbar radicular pain with or without low back pain (LBP) [9,10,11,12,13]
Jeong et al showed that an epidural catheter can be placed at the ventrocaudal aspect of the existing nerve using a contralateral interlaminar retrograde foraminal (CIRF) approach [14]
Summary
Transforaminal epidural steroid injection (TFESI) is one of the most common treatments for the management of chronic lumbar radicular pain, with or without low back pain (LBP), resulting from lumbar spinal stenosis, disc herniation, discogenic pain, and failed back surgery syndrome [1,2,3]. This approach is often only effective for a few weeks and may not improve patients’ disability [4]. Previous studies have shown that the contrast spreads well into the target nerve root and the ventral epidural space [14,15]
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