699: Clinical Efficacy of Caudal Neuroplasty with Navigable Catheter in Refractory Chronic Low Back Pain

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Chronic neuropathic pain, Non-pharmacological treatments, Assessment and Measurement of Pain/Nociception, Pain mechanisms (e.g. descending inhibitory control, placebo, inflammation)

Background and Aims: Lumbar spinal stenosis is identified as a significant cause of refractory chronic low back pain. Often, conservative interventions do not provide sustained clinical benefits, leading to the application of interventional techniques such as neuroplasty. This study aimed to evaluate the association between neuroplasty using a navigable catheter and changes in pain levels in patients diagnosed with refractory chronic low back pain. Additionally, it explored demographic and clinical factors related to refractory chronic low back pain and their impact on the temporal evolution of pain.

Methods: A systematic collection of demographic data was conducted, along with history of alcohol and tobacco use, comorbidities, pain intensity, and its evolution over time at four measurement points: at baseline, immediately post-procedure, at 3 months, and at 6 months post-intervention.

Results: The study included a total of 47 patients with refractory chronic low back pain and a diagnosis of lumbar stenosis. A statistically significant reduction in pain was observed immediately following the procedure. Despite a slight loss of effect at six months, there was no return to baseline pain levels. Interindividual variability persisted, highlighting the necessity for a personalized follow-up approach. No serious adverse events associated with the procedure were reported.

Conclusions: Percutaneous epidural neuroplasty using a navigable catheter is established as a minimally invasive, safe, and effective alternative for treating refractory chronic low back pain. Future prospective studies are needed to better define selection criteria and the sustained duration of clinical benefit.

References: 1. Ferreira ML, Luca K de, Haile LM, Steinmetz JD, Culbreth GT, Cross M, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. June 1, 2023;5(6):e316–29.

2. The Lancet: New study shows low back pain is the leading cause of disability around the world | Institute for Health Metrics and Evaluation [Internet]. [cited April 13, 2025]. Available from: https://www.healthdata.org/news-events/newsroom/news-releases/lancet-new-study-shows-low-back-pain-leading-cause-disability

3. Deer T, Gilligan C, Falowski S, Desai M, Pilitsis J, Jameson J, et al. Treatment of Refractory Low Back Pain Using Passive Recharge Burst in Patients Without Options for Corrective Surgery: Findings and Results From the DISTINCT Study, a Prospective Randomized Multicenter Controlled Trial. Neuromodulation J Int Neuromodulation Soc. October 2023;26(7):1387–99.

4. Spears CA, Hodges SE, Kiyani M, Yang Z, Edwards RM, Musick A, et al. Healthcare Resource Utilization and Management of Chronic, Refractory Low Back Pain in the United States. Spine. October 15, 2020;45(20):E1333–41.

5. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. May 3, 2022;327(17):1688–99.

6. Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural Lysis of Adhesions. Korean J Pain. January 31, 2014;27(1):3–15.

7. Karm MH, Kim CS, Kim DH, Lee D, Kim Y, Shin JW, et al. Effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with chronic spinal stenosis accompanying mild spondylolisthesis: a longitudinal cohort study. Korean J Pain. April 1, 2023;36(2):184–94.

8. Balcázar S. Interventional Pain Techniques. 1st ed. Monterrey, Mexico; 2025. 207 p.

9. Jang JY, Vuttipongkul S, Jang DS, Chang MC. Evaluating the Technical Specifications and Clinical Performance of Different Percutaneous Epidural Neuroplasty Catheters. Neurospine. June 30, 2025;22(2):465–72.

10. Jensen RK, Jensen TS, Koes B, Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J. September 1, 2020;29(9):2143–63.

11. Diwan S, Sayed D, Deer TR, Salomons A, Liang K. An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidence-Based Approach. Pain Med Off J Am Acad Pain Med. December 2019;20(Suppl 2):S23–31.

12. Anderson DB, Beard DJ, Rannou F, Hunter DJ, Suri P, Chen L, et al. Clinical assessment and management of lumbar spinal stenosis: clinical dilemmas and considerations for surgical referral. Lancet Rheumatol. October 1, 2024;6(10):e727–32.

13. Lango N, Adil I, Babar A, Langove A, Ahmed N. Surgical and Nonsurgical Treatment for Lumbar Spinal Stenosis: Three Years’ Experience in Sandeman Teaching Hospital Quetta. J Health Wellness Community Res. May 26, 2025;e280–e280.

14. Louis-Sidney F, Duby JF, Signate A, Arfi S, De Bandt M, Suzon B, et al. Lumbar Spinal Stenosis Treatment: Is Surgery Better than Non-Surgical Treatments in Afro-Descendant Populations? Biomedicines. December 2022;10(12):3144.

15. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. January 29, 2016;2016(1):CD010264.

16. Bydon M, Alvi MA, Goyal A. Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment. Neurosurg Clin N Am. July 2019;30(3):299–304.

17. Aitaha MT, Saeed MAM, Chasib RJ, Hamdan TA. Correlation between degenerative lumbar spinal stenosis and systemic diseases. J Orthop Trauma Surg Relat Res [Internet]. July 30, 2021 [cited January 4, 2026];18(8). Available from: https://www.jotsrr.org/abstract/correlation-between-degenerative-lumbar-spinal-stenosis-and-systemic-diseases-8626.html

18. Choi SS, Lee JH, Kim D, Kim HK, Lee S, Song KJ, et al. Effectiveness and Factors Associated with Epidural Decompression and Adhesiolysis Using a Balloon-Inflatable Catheter in Chronic Lumbar Spinal Stenosis: 1-Year Follow-Up. Pain Med Malden Mass. March 2016;17(3):476–87.

19. Choi SS, Lee JH, Kim D, Kim HK, Lee S, Song KJ, et al. Effectiveness and Factors Associated with Epidural Decompression and Adhesiolysis Using a Balloon-Inflatable Catheter in Chronic Lumbar Spinal Stenosis: 1-Year Follow-Up. Pain Med. March 1, 2016;17(3):476–87

Presenting Author: Italo Caro
Submitting Author: Italo Caro

Senior Author: Silver Balcazar de Leon

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Silver Balcazar de León: FIPP, CIPS - Centro Medico del Dolor, Monterrey, Mexico.
• Gabriela Castro: MD - Centro Medico del Dolor, Monterrey, Mexico
• Maria-Griselda Collado: MD - Centro Medico del Dolor, Monterrey, Mexico
• Jose Vasquez: MD - Centro Medico del Dolor, Monterrey, Mexico
• Marcela Osuna: MD - Centro Medico del Dolor, Monterrey, Mexico