A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression
A 70-year-old man presented with pain in the lower back and both legs. He had undergone a decompressive surgery at the L4-5 level seven years previously. However, his pain had again developed six months prior to presentation. He complained of numbness and a cramping sensation in both legs and could not walk more than 100 meters because of his pain. He scored his pain as 8 on the NRS, and his functional score on the ODI was 40. Left neural foraminal stenosis at the L4-5 and L5-S1 levels and right neural foraminal stenosis at the L3-4 level with degenerative spondylolisthesis, a bulging disc, and facet osteoarthritis were noted by lumbar MRI. The patient had been treated with an epidural steroid injection before visiting our clinic. However, the effect lasted for only two weeks, and his pain was reduced by only 10%.\nTo relieve the patient's pain and extend the duration of pain relief, PEA and decompression with the inflatable balloon neuroplasty catheter were performed as described for Cases 1 and 2. A caudal epidurogram showed a filling defect from the central epidural space above the L5-S1 level to both the L5 and S1 intervertebral foramina. After anterior epidural adhesiolysis and decompression of both neural foramina by mechanical adhesiolysis and balloon inflation as described in Case 1, contrast agent spread throughout both the L5 and S1 intervertebral foramina and the anterior epidural space above the L4-5 level. At the end of the procedure, 6 ml of a mixture of 1% lidocaine, 20 mg triamcinolone, and 1,500 IU hyaluronidase was administered through the catheter. After two months, the patient's pain scores on the NRS and ODI decreased to 4 and 36, respectively. His walking distance also increased to 500 meters. Interestingly, his pain nearly disappeared three months after the procedure, and he has been doing well without pain for more than 18 months following PEA and decompression with the inflatable balloon neuroplasty catheter.