1. 2017;20;E841-E848Factors Associated with Successful Responses to Transforaminal Balloon Adhesiolysis for Chronic Lumbar Foraminal Stenosis: Retrospective Study
   Retrospective Study
   Seong-Soo Choi, MD, PhD, Ji Hyun Park, MD, Jin-Woo Shin, MD, PhD, Jeong-Gil Leem, MD, PhD, Kunhee Lee, MD, Yeon-Jin Moon, MD, Koo Kwon, MD, Seong-Sik Cho, MD, and Doo Hwan Kim, MD.

BACKGROUND: Recently, transforaminal balloon adhesiolysis was introduced to manage patients with chronic radicular pain occurring with or without low back pain. However, the factors associated with successful responses to transforaminal balloon adhesiolysis are not known.

OBJECTIVE: To evaluate the factors associated with successful responses to transforaminal balloon adhesiolysis for chronic lumbar spinal stenosis.

STUDY DESIGN: This is a retrospective observational study.

SETTING: A single pain clinic of tertiary medical center in Seoul, Republic of Korea.

METHODS: From January 2013 to December 2014, a retrospective review of 199 patients with chronic lumbar foraminal stenosis, who were scheduled for transforaminal balloon adhesiolysis, was performed. Patients were considered successful responders if they showed either of the following: 1) a decrease of more than 50% on the numerical rating scale or 2) a decrease of more than 30% on the numerical rating scale and improved functional status 3 months after transforaminal balloon adhesiolysis. Logistic regression analysis was performed to determine the factors associated with successful responses to this surgical procedure.

RESULTS: Three months after the transforaminal balloon adhesiolysis, 49.4% of patients were considered successful responders. Multivariate logistic regression analysis showed that factors other than degenerative disc herniation were independently associated with successful responses 3 months after this surgical procedure (odds ratio = 0.327; 95% confidence interval = 0.129 – 0.827; P = 0.018).

LIMITATIONS: The definition of successful response used in this study differed from the ones used in previous studies; a different definition may have led to different results. Further, the effects of other factors (ballooning, drugs, and saline washes) could not be excluded from our study. In addition, the correct method of assessing functional status, the Oswestry Disability Index, could not be used in this study; hence, the final results may have been affected.

CONCLUSION: These results suggest that transforaminal balloon adhesiolysis can successfully lead to improvement of symptoms in patients with chronic lumbar foraminal stenosis caused primarily by degenerative disc herniation.

Institutional Review Board (IRB) approval number: 2016-0228

Key words: Balloon, epidural adhesiolysis, chronic pain, radicular pain, lumbar spine, foraminal stenosis, degenerative disc