Percutaneous epidural neuroplasty: Transforaminal approach

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.