A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression
A 37-year-old man presented to our office with right buttock pain radiating to the leg. There was no weakness or sensory changes, and his lumbar MRI revealed a huge central disc extrusion and sequestration at central L4-5 region (). The patient was first treated with five epidural steroid injections (two by an interlaminar approach and the others by a transforaminal approach). Although this improved his pain level, the effect did not last for more than three weeks; the patient continued to complain of pain with a score of 7 on the NRS, and he could not walk for more than three minutes. His functional score on the ODI was 38.\nPEA and decompression with the inflatable balloon neuroplasty catheter were planned and prepared as described above. A caudal epidurogram, performed before the insertion of the inflatable balloon neuroplasty catheter, showed a filling defect in the anterior epidural space above the level of L5. When the inflatable balloon neuroplasty catheter was inserted and advanced to the level of L5, some resistance against the catheter was felt. Gentle adhesiolysis of the anterior epidural space by intermittent balloon inflation was performed as described for Case 1, and the spread of contrast medium above the level of disc herniation was confirmed. At the end of the procedure, a Perifix epidural catheter (B. Braun Melsungen AG, Melsungen, Germany) was left at the target site through the balloon catheter lumen. After test injection of 1 ml 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 catheter was removed on the day of the procedure. There were no complications during the procedure. At the follow-up visit after one month, the patient's pain was found to be reduced and was scored as a 1 on the NRS. The patient had no walking limitations, and his functional status was improved, with a change in the ODI score from 38 to 2. The effect has been maintained for more than 13 months, and the patient is currently being monitored on follow-up.