Korean J Pain.  2014 Apr;27(2):178-185. 10.3344/kjp.2014.27.2.178.

A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression

• Choi SS
• Joo EY
• Hwang BS
• Lee JH
• Lee G
• Suh JH
• Leem JG
• Shin JW

• KMID: 2074066
• DOI: http://doi.org/10.3344/kjp.2014.27.2.178

Abstract

Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis.

Keyword

balloon; lumbar disc herniation; percutaneous epidural adhesiolysis; post lumbar surgery syndrome; spinal stenosis

MeSH Terms

Catheters*
Constriction, Pathologic
Decompression*
Humans
Peas
Spinal Nerves
Spinal Stenosis
Walking

Figure

• 

  Fig. 1 The inflatable balloon neuroplasty (ZiNeu) catheter. This instrument can be adjusted from side to side and has an inflatable balloon (arrow) attached to the end of the catheter tip. It also has a channel (arrow-head) to inject drugs or to leave another catheter at the target site for two- or three-day regimens.

• 

  Fig. 2 T2-weighted magnetic resonance images (MRI) of the lumbar spine in a 75-year-old man suffering from pain in his back, both thighs, and calves that persisted for seven months. (A) Sagittal and (B) axial views of the MRI show central stenosis at the L4-5 level caused by a bulging disc, facet arthrosis, and thickening of the ligamentum flavum.

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  Fig. 3 Serial fluoroscopic images of percutaneous epidural adhesiolysis (PEA) using the inflatable balloon neuroplasty catheter. (A) Anteroposterior view verified before the procedure showing filling defects of contrast medium at the epidural space above the level of L5-S1 and both L5 intervertebral foramina. (B) Fluoroscopic view showing the inflatable balloon neuroplasty catheter placed in the L5 intervertebral foramen and the balloon filled with contrast medium. Foraminal stenosis is visualized by the degree of distortion of the balloon (arrow). (C) Decompression is performed along the intervertebral foramen by ballooning. (D) After decompression along the pass from the lateral recess to the intervertebral foramen, the contrast agent spread well. In addition, the contrast agent in the epidural space spread upward above the level of L5-S1.

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  Fig. 4 T2-weighted magnetic resonance images (MRI) of the lumbar spine in a 37-year-old man with right buttock pain radiating to the leg. (A) Sagittal and (B and C) axial views of the MRI show a huge central disc extrusion and sequestration at the L4-5 level.

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