earticle

영어

Failed Back Surgery Syndrome (FBSS) is a condition where persistent neuropathic pain continues despite spinal surgery, often resistant to conventional treatments such as transforaminal epidural block (TFEB). This report presents a 63-year-old female patient who underwent posterolateral fusion (PLF) and interbody fusion (IF) at L4-5 but continued to experience severe low back pain (Numeric rating scale, NRS 7) and radiating pain (NRS 9), along with motor weakness and claudication. MRI revealed foraminal disc extrusion at L5-S1 compressing the left L5 nerve and moderate central spinal stenosis at L3-4. Despite multiple TFEBs, pain relief was only temporary, leading to the decision to perform retrodiscal approach percutaneous epidural adhesiolysis (PEA) using the WHIP catheter® in January 2025. The procedure combined hydraulic force via high-pressure injection of saline and medications with mechanical force through catheter manipulation to disrupt adhesions. Following the procedure, NRS decreased from 7 to 1, and the effect was sustained at one month, with significant improvement in paresthesia, calf pain, and leg swelling. The Patient’s Global Impression of Change (PGIC) score indicated "greatly improved," reflecting high patient satisfaction. This case suggests that retrodiscal approach PEA using the WHIP catheter® may be an effective alternative for FBSS patients unresponsive to TFEB, offering substantial and sustained pain relief. Further studies are needed to establish long-term efficacy and patient selection criteria.