게시판
| 21KS-025 |
Percutaneous lumbar foraminoplasty for lumbar foraminal stenosis: A case report
Department of Anesthesiology and Pain Medicine, Seoul St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Introduction
Foraminal stenosis is one of the mainstays of lumbar radiculopathy. Compression of a nerve root due to hypertrophied superior articular process and ligamentum flavum causes pain in patients refractory to epidural steroid injection. We present this case, in which percutaneous lumbar foraminoplasty was done to successfully treat nerve root compression.
Case report
A 62-year-old man was presented with both-sided buttock pain that radiated to the lateral side of the thigh, lower leg, and sole of the foot. The pain on the left was stronger with radiculopathy of L5 dermatome with a Numeric Rating Scale (NRS) of 9-10/10. He was administered with left L5-S1 and S1 transforaminal epidural steroid injection (TFESI). The injections were not so effective and the symptoms persisted. After the diagnosis of left L5-S1 severe foraminal spinal stenosis, additional treatment of percutaneous lumbar foraminoplasty using Claudicare(SEAWON Meditech, Bucheon-si, Gyeonggi-do, Republic of Korea) was conducted. An imaginary line for the path of an introducer needle was drawn because the correct insertion of which was the most important part. After local anesthesia, it entered at about 10-12cm lateral to the midline, to the target of the anterior surface of the superior articular process through Kambin’s triangle. It was angled steeply due to lumbar spondylosis and obliquely to avoid the iliac crest. A guidewire, a dilator, and a working cannula of 3 mm of outer diameter were inserted. Every step was administered under a fluoroscopic guide. Since the device was half-shielded, the drill inside the working cannula was able to safely trim hypertrophied superior articular process, ligamentum flavum, and other soft tissues. The entire procedure took about 30 minutes. Subsequently, during the following visit of 4 weeks, the patient’s symptoms were alleviated and the NRS score has decreased from 9-10/10 to 1-2/10. Still, the patient described the remaining radiculopathy on the right side as 4/10 of the NRS score.
Conclusion
Percutaneous lumbar foraminoplasty proved to be highly effective for lumbar foraminal stenosis.
Reference
Yoo, Yongjae et al. “Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis.” Medicine vol. 98,15 (2019): e15169. doi:10.1097/MD.0000000000015169
Foraminal stenosis is one of the mainstays of lumbar radiculopathy. Compression of a nerve root due to hypertrophied superior articular process and ligamentum flavum causes pain in patients refractory to epidural steroid injection. We present this case, in which percutaneous lumbar foraminoplasty was done to successfully treat nerve root compression.
Case report
A 62-year-old man was presented with both-sided buttock pain that radiated to the lateral side of the thigh, lower leg, and sole of the foot. The pain on the left was stronger with radiculopathy of L5 dermatome with a Numeric Rating Scale (NRS) of 9-10/10. He was administered with left L5-S1 and S1 transforaminal epidural steroid injection (TFESI). The injections were not so effective and the symptoms persisted. After the diagnosis of left L5-S1 severe foraminal spinal stenosis, additional treatment of percutaneous lumbar foraminoplasty using Claudicare(SEAWON Meditech, Bucheon-si, Gyeonggi-do, Republic of Korea) was conducted. An imaginary line for the path of an introducer needle was drawn because the correct insertion of which was the most important part. After local anesthesia, it entered at about 10-12cm lateral to the midline, to the target of the anterior surface of the superior articular process through Kambin’s triangle. It was angled steeply due to lumbar spondylosis and obliquely to avoid the iliac crest. A guidewire, a dilator, and a working cannula of 3 mm of outer diameter were inserted. Every step was administered under a fluoroscopic guide. Since the device was half-shielded, the drill inside the working cannula was able to safely trim hypertrophied superior articular process, ligamentum flavum, and other soft tissues. The entire procedure took about 30 minutes. Subsequently, during the following visit of 4 weeks, the patient’s symptoms were alleviated and the NRS score has decreased from 9-10/10 to 1-2/10. Still, the patient described the remaining radiculopathy on the right side as 4/10 of the NRS score.
Conclusion
Percutaneous lumbar foraminoplasty proved to be highly effective for lumbar foraminal stenosis.
Reference
Yoo, Yongjae et al. “Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis.” Medicine vol. 98,15 (2019): e15169. doi:10.1097/MD.0000000000015169
