title: Comparison of the Ventral Epidural Spreading in Modified Interlaminar Approach and Transforaminal Approach: A Randomized, Double-Blind Study.
abstract: To evaluate the effectiveness of a modified interlaminar (MIL) approach for accessing ventral epidural space compared with the transforaminal (TF) approach.
  
  
  
  Randomized double blinded control trial
  
  
  
  Eighty-four patients with lumbar radicular pain were randomly assigned into two groups in which drug delivery to the ventral epidural space was performed through either the MIL (n = 42) or the TF approach (n = 42). Within each group, subgroups were classified according to the dominant pathology as assessed by magnetic resonance imaging (MRI): bulging disc, herniated nucleus pulposus (HNP), and foraminal stenosis. Degenerative changes such as scoliosis and facet hypertrophy was also evaluated.
  
  
  
  The overall accessibility to the ventral epidural space was similar between the two groups. In cases with foraminal stenosis, the success rate of ventral epidural spreading was significantly higher in the MIL group compared with the TF group (TF approach = 50.00% vs MIL approach = 100.00%, P = 0.013). Medial spread of contrast was more dominant in the MIL group (P < 0.001). There was no significant difference between the two groups in overall clinical outcome. The total success rate of accessing the ventral epidural space in degenerative bony changes was higher in the MIL group than in the TF group (TF approach = 57.1% vs MIL approach = 84.6%), but the difference was not statistically significant.
  
  
  
  In cases where access to the ventral epidural space by conventional approach is limited, our MIL approach can be considered a suitable alternative, especially in the case of foraminal stenosis.
authors: *Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea pandjo@naver.com.
authors: Eung Don
authors: ED
authors: Kim
authors: *Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors: Mi Sun
authors: MS
authors: Roh
authors: *Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors: Jun Jae
authors: JJ
authors: Park
authors: *Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
authors: Daehyun
authors: D
authors: Jo
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage*; D007268:Injections, Epidural / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D017116:Low Back Pain; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase
keywords: Epidural (Injection Space); Nerve Block; Randomized Controlled Trial; Spinal Stenosis