Epiduroscopy: Complications and troubleshooting

Avellanal, Martı́n; Diaz-Regañon, Gonzalo; Orts, A; Gonzalez-Montero, Lucio; Ares, Javier De Andrés

doi:10.1053/j.trap.2015.01.006

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…Therefore, it is difficult to set a particular cut-off point for the volume of injectate. The results of the present study show that injectate volume greater than 60 cc can lead to greater increases in ICP compared to lower volumes [7]. In addition, our results suggest that high-volume fluid treatment can lead to neurological deterioration, particularly in patients with undiagnosed intracranial compliance.…”

Section: Dıscussıonsupporting

confidence: 50%

“…Sixty adult patients undergoing epiduroscopy at Konya Training and Research Hospital for treatment of low back pain were enrolled. Although there is no recommendation for the maximum volume of injectate to use during epiduroscopy, we set 60 cc volume as a cut-off point according to published studies on related complications of epiduroscopy [7]. Therefore, the patients receiving 60 ml or more were assigned to the high-volume (HV) group and the others were assigned to the low-volume (LV) group.…”

Section: Methodsmentioning

confidence: 99%

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Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Epiduroscopy

Tire

Çöven²,

Cebeci

et al. 2019

Med Sci Monit

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Departmental sources Background: Epiduroscopy is commonly used for the evaluation and treatment of low back pain. Saline with or without local anesthetic addition was used to visualize epidural space structure during this procedure. A rapid increase in epidural space pressure is transmitted into the spinal space to the optic nerve sheath. This study aimed to estimate the effects of epiduroscopy on optic nerve sheath diameter (ONSD) according to the volume of fluid using the ultrasonographic measurement of optic nerve diameter in adult patients. Material/Methods: Sixty patients who had been treated for low back pain with epiduroscopy using low-volume (LV) or high-volume (HV) fluid application were enrolled into the study. Measurement of ONSD was performed before (T0) and immediately after epiduroscopy (T1), at 10 min (T2), and 20 min (T3) after the epiduroscopy. Results: Both groups showed significant differences over time in ONSD (PGroup×Time=0.001). The HV group showed greater changes from T0 to T2 and T3 than the LV group in ONSD. However, in both groups, ONSDs at T2 and T3 were significantly larger than those with the highest values at T2 compared to T0. Conclusions: Ultrasonography of ONSD presents a good level of diagnostic accuracy for identifying epidural hypertension. In the clinical decision-making phase, this may help physicians to be more cautious about volume when performing epidural injections to treat this disease.

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Section: Dıscussıonsupporting

confidence: 50%

Section: Methodsmentioning

confidence: 99%

Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Epiduroscopy

Tire

Çöven²,

Cebeci

et al. 2019

Med Sci Monit

View full text Add to dashboard Cite

show abstract

“…From the table, it can be seen that the general rule as suggested by Avellanal et al ( 12 ) of a maximum total injected fluid volume of 60 ml over 60 min, may not keep the epidural pressure below 60 mmHg in all patients. Since adverse conditions cannot be reliably identified, the results of the above analysis suggest that some type of pressure or neuromonitoring such as electrophysiological response testing or direct communication with an awake and responsive patient is imperative.…”

Section: Total Injected Volumementioning

confidence: 89%

Pressure-Volume Relationships in the Spinal Canal and Potential Neurological Complications After Epidural Fluid Injections

Bosscher

2022

Front. Pain Res.

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High-volume fluid injections into the spinal canal may lead to severe neurological complications. But when anatomical or pathological conditions in the spinal canal are unfavorable, even small volume epidural injections can cause dangerously high epidural, subarachnoid, and intracranial pressures or pressure gradients. Data obtained from the scientific literature and direct clinical observation are used to derive a first-order approximation of epidural, subarachnoid, and intracranial pressure responses to epidural fluid injections. Maximum allowable fluid volumes for single or multiple divided fluid injections over time are calculated. In the presence of spinal pathology, 10 ml of fluids may increase epidural pressure to >100 mmHg. Injection speed >4 ml per second may also generate dangerously high intraspinal and intracranial pressures. Intermitted bolus injections provide limited protection, but intraspinal pressures may rise very fast when a critical total injected volume is reached. Potential complications of increased intracranial pressures or large pressure waves include nerve palsies, tinnitus, blindness, stroke, and death. Spinal injections or endoscopy should be performed in an awake responsive patient or with direct cerebrospinal fluid pressure monitoring. A set of guidelines for epidural fluid management is given.

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“…The complications that have been described in the literature after an epiduroscopy are generally minor and transitory. A systematic review conducted on 391 patients found only 14 cases of serious complications (7), such as retinal hemorrhages, or encephalopathy and rhabdomyolysis due to the contrast medium injection (5).…”

Section: Discussionmentioning

confidence: 99%

Catastrophe Disguised as a Complication After Epiduroscopy-A Case Study

Monzón¹

2021

PMCR

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Background: Epiduroscopy is a minimally invasive technique that enables diagnosis and treatment within the epidural space with direct vision. Previously reported complications of this technique have been mostly mild neurological complications of a transitory nature. In the present case, we describe a serious complication following an epiduroscopy, resulting in death. Case Report: The patient was a 39-year-old woman with lower back and lower limb pain who had undergone 3 surgical interventions previously on the lumbar spine. Only limited results from conservative and interventional treatment had been observed. She underwent an epiduroscopy in the Pain Management Unit. Immediately after the procedure, which was completed without incident, the patient presented neurological symptoms with areflexic paraplegia and a loss of sensation in the lower limbs and the upper left limb. Imaging tests identified signs of craniospinal hypotension that progressed slowly despite medical intervention. Ventricular dilation and cerebral edema without remission occurred, which ultimately caused the patient’s death 2 months after admission to the intensive care unit. Conclusion: Epiduroscopy has the potential to present adverse effects and complications. A thorough evaluation of the clinical history and the imaging tests are advisable Key words: Complications, epiduroscopy, low back pain, spinal cord, spinal endoscopy

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Epiduroscopy: Complications and troubleshooting

Cited by 6 publications

References 19 publications

Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Epiduroscopy

Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Epiduroscopy

Pressure-Volume Relationships in the Spinal Canal and Potential Neurological Complications After Epidural Fluid Injections

Catastrophe Disguised as a Complication After Epiduroscopy-A Case Study

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