Anesth Pain Med.  2021 Apr;16(2):191-195. 10.17085/apm.20084.

Successful electrode insertion for spinal cord stimulation after balloon adhesiolysis in a patient with epidural adhesion - A case report -

• Hyun DM
• Park CH
• Kim Y
• Choi SS

• KMID: 2515546
• DOI: http://doi.org/10.17085/apm.20084

Abstract

Background
Spinal cord stimulation (SCS) can be successfully performed using highly developed implantation techniques. However, anatomical barriers, such as epidural adhesion, may impede placing the electrode for SCS in an adequate position. Case: A 60-year-old woman who had SCS with an electrode at the T9-10 level removed because she had a wound infection at the back incision site. After the wound infection was completely resolved, we tried to re-insert the SCS electrode. However, it was difficult to advance it up to the T11 level due to epidural adhesion. We performed a combined epidural adhesiolysis using balloon decompression with an inflatable balloon catheter. After that, the SCS lead was successfully placed up to the T11 level, and implantation of SCS was performed.
Conclusions
When a patient has epidural adhesion, an epidural adhesiolysis with an inflatable balloon catheter may help the insertion of the SCS electrode in the epidural space.

Keyword

Epidural adhesion; Epidural adhesiolysis; Inflatable balloon catheter; Spinal cord stimulation

Figure

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  Fig. 1. Contrast dye was not spread above the T11-12 epidural space under fluoroscopic view.

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  Fig. 2. Fluoroscopic view showing the position of inflatable balloon catheter in the T11 epidural space. The balloon filled with contrast medium are shown at T10-11 level. (A) Fluoroscopic anteroposterior view, (B) Fluoroscopic lateral view.

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  Fig. 3. Postoperative X-ray (anteroposterior view) of a round type lead placed at the T9-10 level, connected to a rechargeable implantable pulse generator. The electrode was placed through the contralateral L1-2 epidural space to evade the previous infection site.

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