A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression
A 44-year-old female presented with pain in the lower back radiating to the right leg. Her symptoms first developed three years ago. When she walked for 10 minutes, her pain was aggravated and accompanied by numbness with a cramping sensation in the right leg. There was no weakness or sensory changes. No abnormal signs were seen on physical examination. For three years, she had been treated with oral medication and three sets of epidural steroid injections. The effect of the third epidural steroid injection did not last for more than one month. Moreover, PEA with the Racz catheter did not effectively reduce her pain level. The patient continued to complain of pain with a score of 8 on the NRS and she could not walk for more than ten minutes. His functional score on the ODI was 64. Her lumbar MRI revealed central disc extrusion at the L4-5 level with central canal stenosis, and bilateral L5 nerve root compression.\nWe planned PEA and decompression with the inflatable balloon neuroplasty catheter, and prepared as described above. A caudal epidurogram showed a filling defect from the central epidural space at the L4-5 level to both L5 intervertebral foramina (especially the preganglionic area). Gentle adhesiolysis of the preganglionic area at the right L5 level by intermittent balloon inflation was performed as described above, and the preganglionic spread of contrast medium was confirmed. At the end of the procedure, a Perifix epidural catheter was left at the target site through the balloon catheter lumen. After test injection of 1 ml of lidocaine, 6 ml of a mixture of 1% lidocaine and 1,500 IU hyaluronidase was administered through the Perifix catheter. After 10 to 15 minutes of monitoring, another 4 ml of a mixture of 10% hypertonic saline and 20 mg triamcinolone was injected through the catheter. The Perifix catheter was left in place for a 2-day drug injection. The catheter was then removed on the second day of the procedure, after injection of the same drugs, including the hypertonic solution. There were no complications during the procedure. At the follow-up visit after two months, the patient's pain was found to be reduced and was scored as a 2 on the NRS. The patient reported an improvement in her walking distance, and her functional status was also improved, with a change in the ODI score from 64 to 26. The effect has been maintained for more than seven months, and the patient is currently being monitored on follow-up.