Anesth Pain Med.  2018 Jul;13(3):302-307. 10.17085/apm.2018.13.3.302.

Application of percutaneous foraminotomy with a specially designed drill tip for foraminal stenosis patient: A case report

• Choo H
• Sim SE

• KMID: 2436039
• DOI: http://doi.org/10.17085/apm.2018.13.3.302

Abstract

This case report describes a new method of pain management intervention: percutaneous foraminotomy using the Claudicare system (Seawon Meditech, Korea). In this case, a 77-year-old Asian man visited the hospital with motor weakness in his left foot. He was diagnosed with L4-5 grade three foraminal stenosis using Magnetic Resonance Imaging on both sides. A left L4-5 foraminal decompression was performed using percutaneous foraminotomy. The patient revisited the hospital after 17 months because the same symptoms recurred in his right foot. We observed that the symptoms on the left foot had disappeared completely. We confirmed the lesion on the right side and the postoperative change on the left side on the magnetic resonance imaging (MRI) image. Both the pre- and postoperative MRI images were compared by measuring the dimensions of the foraminal area (28.12 mm² vs. 38.58 mm², repectively). T1W images showed signs of increased epidural soft tissue after percutaneous foraminotomy.

Keyword

Foraminotomy; Spinal stenosis; Spine

MeSH Terms

Aged
Asian Continental Ancestry Group
Constriction, Pathologic*
Decompression
Foot
Foraminotomy*
Humans
Magnetic Resonance Imaging
Methods
Pain Management
Spinal Stenosis
Spine

Figure

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  Fig. 1 Initial lumbar spine magnetic resonance imaging shows foraminal stenosis at L4–5 level. (A) Sagittal view (arrow: Left L4–5 intervertebral foramen), (B) Axial view.

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  Fig. 2 Fluoroscopy images of percutaneous foraminotomy. (A) Anteroposterior view, guide wire to Kambin’s triangle, (B) lateral view, guide wire to Kambin’s triangle, (C) lateral view, dilator insertion, and (D) lateral view, working channel insertion.

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  Fig. 3 Instruments for percutaneous foraminotomy: (A) Dilator, guide wire, (B) Working cannula with an epiduroscope port, (C) Claudicare with bird-beak-shaped shield (arrowhead).

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  Fig. 4 Fifteen months after initial L4–5 percutaneous foraminotomy magnetic resonance imaging. (A) Sagittal view and (B) axial view.

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  Fig. 5 Schematic image of intervertebral foramen. Red area is foraminal area that is used to calculate the dimension of foramen.

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  Fig. 6 T2-weighted magnetic resonance sagittal images pre- (A) and post-Claudicare (B) imaging at foraminal plane.

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  Fig. 7 T1-weighted magnetic resonance axial images pre- (A) and post-Claudicare (B) imaging.

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  Fig. 8 Schematic image of neural foramen and target of drilling. Red circle: placement of Claudicare. Arrow: bulging disc. Arrowhead: hypertrophy of superior articular process. Gray lines: thickened transforaminal ligament filled in the foraminal space. VB: vertebral body, SAP: superior articular process.

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