Contralateral retrodiscal transforaminal approach for percutaneous epidural adhesiolysis: A technical description and retrospective comparative study

• Published in: Pain practice 2022-04, Vol.22 (4), p.424-431
• Main Authors: You, Ki‐Han, Park, Hyun‐Jin, Son, In‐Seok, Chung, Hoon‐Jae, Kang, Min‐Seok
• Format: Article
• Language: English
• Subjects: contralateral retrodiscal transforaminal approach; Epidural Space; epidural steroid injection; Humans; Injections, Epidural - methods; intradiscal injection; intravascular injection; Low Back Pain - drug therapy; Low Back Pain - etiology; Low Back Pain - surgery; Lumbar Vertebrae; percutaneous epidural adhesiolysis; Radiculopathy - drug therapy; Radiculopathy - etiology; Radiculopathy - surgery; Retrospective Studies; Treatment Outcome
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.13096

Objectives Retrodiscal transforaminal (RdTF) epidural steroid injection (ESI) is clinically comparable to conventional transforaminal ESI and can avoid catastrophic complications. However, it poses a risk of inadvertent intradiscal, intravascular, and intrathecal injections. Therefore, we aimed to evaluate the feasibility of percutaneous epidural adhesiolysis (PEA) using the contralateral (Contra)‐RdTF approach. Methods The electronic medical records of 332 patients with unilateral lumbar radiculopathy due to foraminal disk pathology were reviewed. Patients were categorized into two groups: Group A (ESI using the RdTF approach) and Group B (PEA using the Contra‐RdTF approach). Effective pain relief (EPR; ≥50% pain relief from baseline) in patients was evaluated using the visual analog scale (VAS) at 4 and 12 weeks after the procedure. The presence of unintended fluoroscopic findings and complications was recorded. Results A total of 119 patients were enrolled in the final analysis: 81 in Group A and 38 in Group B. Both groups showed lesser VAS scores after 4 and 12 weeks than at baseline (p