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Percutaneous Epidural Neuroplasty: Transforaminal Approach

  • Javier Quillo-Olvera
  • Jin-Sung Kim
Chapter

Abstract

Chronic low back pain associated or not with radicular pain is a serious health problem that affects the majority of the population at least once in life. The social, labor, and psychological impact are important, mainly in people of productive age. The role of epidural fibrosis as a cause of these conditions even after apparently successful lumbar surgery is relevant. When conservative treatment and epidural steroid injections have failed, before thinking about an upcoming surgery, percutaneous epidural neuroplasty has shown encouraging results in the management of these pain syndromes. Especially when dealing with recurrent lumbar radicular pain originated on high lumbar levels, transforaminal percutaneous epidural neuroplasty can be an appropriate option for the successful treatment of unilateral lumbar radiculopathy associated or not with axial pain. The basis of this technique is the greater accuracy towards the foraminal area and lateral recess where chronic radiculopathy generates the patient’s symptoms. And although epidural neuroplasty through the caudal approach has shown encouraging results, the access specifically in these areas of the spinal canal can be difficult, and it can determine an unsatisfactory mechanical and chemical adhesiolysis and, consequently, a therapeutic failure regarding the symptoms of the patient.

Keywords

Low back pain Epidural fibrosis Adhesiolysis Neuroplasty Transforaminal 

Abbreviations

DRG

Dorsal root ganglion

DSP

Dexamethasone sodium phosphate

FBSS

Failed back surgery syndrome

FDA

Food and drug administration

LDH

Lumbar disc herniation

LSS

Lumbar spinal stenosis

MRI

Magnetic resonance imaging

NaCl

Sodium chloride solution

NRS

Numeric rating scale

NSAIDs

Nonsteroidal anti-inflammatory drugs

ODI

Oswestry disability index

OPN

Osteopontin

PEN

Percutaneous epidural neuroplasty

SFM

Short form McGill questionnaire

SIBLING

Small integrin binding ligand N-linked glycoprotein

TA

Triamcinolone acetonide

VAS

Visual analogue scale

VNRS

Verbal numeric rating scale

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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Javier Quillo-Olvera
    • 1
  • Jin-Sung Kim
    • 1
  1. 1.Spine Center, Department of NeurosurgerySeoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea

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