Spinal Epidural Balloon Decompression and Adhesiolysis

274 Pages·2021·30.834 MB·English

by  Jin Woo Shin

Spinal Epidural Balloon
Decompression and
Adhesiolysis
Jin Woo Shin
Spinal Epidural Balloon
Decompression and Adhesiolysis
Jin Woo Shin
Spinal Epidural Balloon
Decompression and
Adhesiolysis
Jin Woo Shin
Department of Anesthesiology and Pain Medicine
ASAN Medical Center
Seoul
Korea (Republic of)
ISBN 978-981-15-7264-7 ISBN 978-981-15-7265-4 (eBook)
https://doi.org/10.1007/978-981-15-7265-4
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Before After

Using spinal epidural balloon decompression and adhesiolysis to overcome the limitations
of existing nonsurgical treatment modalities. Mastery of this technique will yield a broader
understanding of epidural procedures, including neuroplasty “Beyond the percutaneous
epidural adhesiolysis”
v
Preface
However well imagined or planned at the outset, professional trajectories
may sometimes take unexpected or unintended directions. In my case, this
applies to 16 years of my life as a professor of anesthesiology and pain medi-
cine at Asan Medical Center. While being the first in the world to develop and
establish the medical basis for spinal epidural balloon decompression and
adhesiolysis and genicular nerve radiofrequency ablation are achievements
that I could not have fathomed when I began my career, I have derived much
satisfaction from the fruition of the work and found its progression very
rewarding.
As we enter into an aging society, the number of patients suffering from
degenerative spinal disease will increase. However, many feel frustrated with
current therapeutic modalities, including surgery, as they often fail to yield
satisfactory outcomes. These unaddressed needs have fed my continued inter-
est in novel procedural techniques, and I have often found myself explaining
such frustration to those around me. Then, 1 day, my wife casually mentioned
an idea about balloons: this became the advent of my conception of the bal-
loon procedure.
Looking back, it is clear that many revolutionary inventions in one field
were informed by ideas from a completely different field. I believe balloon
decompression to be a similar case. The fact of the matter is that it would
have been difficult for spine specialists like me to come up with an idea about
a balloon. This limited imagination is rooted in an inflexibility of thought and
an excessively narrow preoccupation with existing methods that make it dif-
ficult for us to conceive of the use of a balloon to attenuate hard stenosis.
While I thought that the balloon was a refreshingly novel idea when I had first
heard of it, I did not believe that it would be effective. However, data from
initial research showed that this method achieved a startling degree of pain
mitigation: an initial success that ushered the commencement of full-fledged
research and development efforts. The discussion of a specialty distinct from
our own tends to meet with disinterest, but the sharing of information and
engagement in discussions with people from other fields can often help fuel
innovation. Creating as much opportunity as possible for interdisciplinary
communication and interaction has time and again demonstrated the potential
for engendering progress.
When treating patients in hospital settings, people often find many areas
that require improvement. However, while most people think about what is
needed and how certain problems should be fixed, they do not put forth the
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viii Preface
effort required to actually fix the identified issues. While working as a profes-
sor, I often thought that while medicine in Korea has reached a world-class
level of excellence, we should not be satisfied with just being able to profi-
ciently use existing techniques or equipment; instead, we should improve
such techniques or instruments and introduce novel therapeutic modalities to
the world. I believe such thoughts and interests have led to the development
of this procedural technique. My colleagues and students who saw the devel-
opment process often told me that, when treating patients, they now think
about how existing methods can change or whether they can be replaced.
They have undergone a similar, desirable transformation: no longer satisfied
with just learning existing medicine, they have begun the pursuit of better
methods.
I did not perform many neuroplasty or adhesiolysis procedures since I did
not believe that such procedures offered sufficient improvement. Rather, as I
studied the balloon decompression technique, I realized why the neuroplasty
or adhesiolysis operations that I had performed did not yield satisfactory
results. These reasons include the appropriate selection of patients for spe-
cific procedures and the inadequate performance of procedures. In other
words, I mistakenly believed myself to be an expert and blamed the technique
or equipment whenever the outcome was unsatisfactory. I had lived under the
false impression that I knew the subject well and did not even research the
topic thoroughly.
As I became increasingly engaged in my research into balloon decompres-
sion procedure, I continued to gather and compare data on how and where to
perform the procedure to increase the likelihood of improvement; all signifi-
cant facts engendered by my research on balloon decompression have been
included in this book. Because such information is related to neuroplasty and
adhesiolysis, reading this book will help develop a better understanding of
those procedures as well.
I have often felt that focusing on study or research of one specific field
facilitates the understanding of other fields. I hope that readers of this book
will have the same experience.
I had never thought about writing a single-volume book because I did not
have anything specific to write about. Even if I was to write a book, it would
simply comprise a compilation of references to foreign books or articles,
which would have been too difficult a task relative to its value. However, I
decided to write and publish this based on the fact that there was a need to
organize the material into the form of a book since it was difficult to accu-
rately relay all of the key concepts during lectures on balloon decompression
alone. Moreover, the amount of material left precluded the retention of how
exactly to apply the technique on actual patients.
This volume is the product of my attempt to include everything I know
about this field. I sincerely hope that this book will be of great help to its
readers.
Seoul, South Korea Jin-Woo Shin
March 1, 2020
Letter of Recommendation
I believe it has been over 20 years since I have known Professor Jin-Woo
Shin. I saw him often and became acquainted with him during his residency
at Asan Medical Center, where he showed much interest in pain medicine and
actively participated in society events. Since he became a professor at Asan
Medical Center, we have become closer personally as well.
Professor Jin-Woo Shin is passionate about pain medicine and has demon-
strated excellent performance in research, which has culminated in the publi-
cation of his work in renowned international journals and has made possible
the systematization of genicular nerve radiofrequency ablation as well as the
development of epidural balloon decompression, a novel therapeutic
modality.
I have recently retired from the Department of Anesthesiology and Pain
Medicine at Seoul National University. During my long tenure as a professor
at Seoul National University, I had invested much effort into the advancement
of the Korean Pain Society. I now find it personally fulfilling to see that the
quality of the Korean Pain Society has been raised to a level of international
recognition.
Recently, an increasing number of physicians in Korea have developed
various procedural techniques and equipment that have become introduced
on a global stage. Beginning in an era when we used to learn techniques from
overseas, we have advanced to the point of developing excellent techniques
that are being taught overseas.
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x Letter of Recommendation
Developed by Professor Jin-Woo Shin, genicular nerve radiofrequency
ablation and epidural balloon decompression are outstanding techniques
among those referred to above, and their academic bases have been well
proven. The equipment used in epidural balloon decompression must receive
certification from overseas markets, preventing overseas physicians from
using the procedure at this point. However, once the necessary certification
has been obtained, it will surely become a universal procedure worldwide. It
is my understanding that genicular nerve radiofrequency ablation is already
being received with much interest overseas since it can be performed easily
with existing equipment.
This book is a compilation of two procedural methods developed by
Professor Jin-Woo Shin. He has included details that will allow physicians
with little experience in this type of procedure to easily and safely perform
the procedure, which in and of itself demonstrates the methodical o rganization
of his research findings to date; this book will thus prove of undoubted help
to anyone interested in this procedure.
I hope that Professor Jin-Woo Shin will continue to upgrade this proce-
dural method and develop other novel techniques.
My sincerest congratulations to Professor Jin-Woo Shin for the publica-
tion of his book, Spinal Epidural Balloon Decompression and Adhesiolysis.
Sang-Chul Lee
Korean Society of Integrative Medicine
Seoul, South Korea
Korean Pain Society
Seoul, South Korea
Korean Pain Research Society
Seoul, South Korea
Letter of Recommendation
Through spinal epidural balloon decompression and adhesiolysis, the main
topic of this book, we are looking at a previously unimagined horizon for
percutaneous epidural adhesiolysis. Our attention is naturally drawn to spinal
epidural balloon decompression and adhesiolysis since it can resolve the
thirst that could not be quenched with existing percutaneous epidural adhe-
siolysis. From this perspective, my personal view is that the subtitle of this
book—“beyond the percutaneous epidural adhesiolysis”—is not an over-
statement by any means.
Spinal epidural balloon decompression and adhesiolysis can be divided
into two aspects: (1) clinical trial results and (2) equipment for the
procedure.
With respect to clinical trial results, I would like to express my respect to
the author for having brought his extensive experience and reflections to bear
and recognize the immeasurable value of this book that provides a vehicle for
these experiences and reflections. This book contains the lengthy experience
of the author and thus provides clinically useful information, including the
appropriate selection of patients for the application of spinal epidural balloon
decompression and adhesiolysis; specific details about approaches for reach-
ing the target points; functional improvement following the procedure; and
positive predictive factors. They say that the typical life cycle for the system-
atic review of an article is 5 years. Considering that the author is already
approaching 10 years of performing spinal epidural balloon decompression
xi