Interlaminar approach for epiduroscopy in patients with failed back surgery syndrome

Avellanal, Martı́n; Diaz-Regañon, Gonzalo

doi:10.1093/bja/aen165

Cited by 40 publications

(54 citation statements)

References 10 publications

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“…3,9 These are well-known symptoms in patients who are referred to epiduroscopy or epidurolysis and are directly related to the pressure of injection. Patients with spinal stenosis or with severe epidural fibrosis, which stops cranial or caudal fluid diffusion, can suffer TNS with slow volumes of fluid injection.…”

Section: Transient Neurologic Symptomsmentioning

confidence: 99%

“…3 Otherwise, serious complications such as retinal impairment can appear. Some authors 9,18 propose to monitor epidural pressure and limit it to an upper level of 50-60 mm Hg.…”

Section: Transient Neurologic Symptomsmentioning

confidence: 99%

“…In 1996, the US Food and Drug Administration approved epiduroscopy for visualizing the epidural space. In 2008, the first clinical results of an interlaminar approach for epiduroscopy in patients with FBSS were described, 3 and other approaches such as retrograde or transforaminal are nowadays performed. However, epiduroscopy as an invasive procedure bears undesirable side effects related to the technique itself, the administered drugs, or other adjuvant devices used (laser, radiofrequency, and Fogarty catheter).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epiduroscopy: Complications and troubleshooting

Avellanal

Diaz-Regañon

Orts

et al. 2014

Techniques in Regional Anesthesia and Pain Management

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Section: Transient Neurologic Symptomsmentioning

confidence: 99%

“…3 Otherwise, serious complications such as retinal impairment can appear. Some authors 9,18 propose to monitor epidural pressure and limit it to an upper level of 50-60 mm Hg.…”

Section: Transient Neurologic Symptomsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epiduroscopy: Complications and troubleshooting

Avellanal

Diaz-Regañon

Orts

et al. 2014

Techniques in Regional Anesthesia and Pain Management

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“…(35)(36)(37) que puede utilizarse en caso de problemas de acceso por el hiato sacro. Para realizar este procedimiento se inserta una aguja epidural 14g (tuohy, Coudé) en el espacio interlaminar L5-S1 con técnica de pérdida de resistencia y ayudados por fluoroscopia.…”

Section: Tiempo Quirúrgicounclassified

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

Iglesias

Nieto

2014

Rev. Soc. Esp. Dolor

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Nieto Iglesias C, Andrés Nieto I. Epiduroscopia (interventional endoscopy spinal surgery). Procedimiento endoscó-pico quirúrgico espinal. Rev Soc Esp Dolor 2014; 21(5): 281-293. INTRODUCCIÓNLa epiduroscopia, endoscopia espinal o también llamado IESS (interventional endoscopy spinal surgery -procedimiento endoscópico quirúrgico espinal) es un procedimiento de los llamados mínimamente invasivos, que permite visualizar el espacio epidural (en tiempo real) con fines diagnósticos y terapéuticos, en pacientes que padecen lumbalgia o lumbociatalgias crónicas refractarias a tratamientos convencionales, mediante la utilización de un epiduroscopio flexible, de pequeño tamaño, con una fibra óptica insertada y con la posibilidad de utilizar pequeños instrumentos para el tratamiento de los pacientes.La lumbalgia o lumbociatalgia se ha transformado en un grave problema sanitario y social ya que la incidencia anual afecta, en un 45 %, a la población de entre 35 y 50 años, constituyendo el 13 % de las causas de absentismo laboral, cifras que van en aumento exponencial, dada nuestra larga esperanza de vida. Lo cierto es que el 80-90 % de la población general padecerá este tipo de dolor alguna vez en la vida. Afortunadamente, estos episodios (60-80 %) ceden en el plazo de pocas semanas, pero alrededor de un 7-10 % desarrollarán dolor crónico (aunque para algunos autores esta cifra puede alcanzar hasta el 33 %) (1), lo que les hace subsidiarios de múltiples tratamientos médicos y quirúrgicos, que pueden fracasar, con un impacto brutal sobre su calidad de vida y estado funcional, así como un tremendo coste social (2).Según las diferentes publicaciones se considera que entre un 40 a un 80 % de los pacientes que han sufrido una intervención quirúrgica sobre la columna vertebral, mantendrán algún tipo de dolor e incluso empeorarán, o lo que es lo mismo, solo uno de cada cuatro experimentarán alguna mejoría. Este problema se denomina "síndrome de cirugía fallida de espalda" o en inglés "failed back surgery syndrome" (FBSS). Los peores resultados afectarán a aquellos pacientes que sufran más de una intervención (3). Este cuadro clínico, que consiste en la persistencia de dolor lumbar con o sin irradiación a miembros inferiores, constituye la mayor fuente de pacientes subsidiarios de esta técnica.El IESS ofrece una serie de ventajas sobre otros procedimientos, siendo poco agresivo y con escasas complicaciones, tales como:1. Visualización de tejidos normales y anormales (adherencias, inflamación…), tanto del espacio epidural posterior (espacio de trabajo habitual para la lisis de adherencias) como anterior. 2. Posibilidad de realización de biopsias. 3. Confirmación el diagnóstico del origen del dolor. 4. Lavado de sustancias proinflamatorias y algogénicas en el lugar de la lesión (mediante infusión de suero salino). 5. Depósito de sustancias terapéuticas en el lugar de la lesión (anestésicos locales, hialuronidasa, corticoides, ozono, clonidina…). 6. Lisis mecánica de adherencias (con balón o el propio epiduroscopio) y/o mediante la utili...

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“…Epiduroscopy is also a minimally invasive technique that offers diagnostic and therapeutic advantages in cases of chronic low back pain and radiculopathy. Saline instillation is used for distending the epidural space, but it cannot overcome fibrotic obstructions of the channel [2].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Epidural Neuroplasty Utilizing Adhesiolysis by Means of Hydraulic and Mechanical force

Aoi¹,

Chen²,

Lui³

et al. 2018

J. Biomed

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Background: Sciatica due to contained herniated discs can be managed with epidural neuroplasty which has emerged as a minimally invasive technique for the treatment of low back pain. Epiduroscopy also provides an alternative minimally invasive technique that offers diagnostic and therapeutic advantages. However, both procedures are not free of complications. The most commonly seen complications are related to the drugs and hypertonic fluid administered. The aim of this retrospective study is to evaluate the efficacy of epidural neuroplasty in the treatment of degenerative chronic low back pain and radiculopathy, and the prevention of complications by means of hydraulic and mechanical adhesiolysis with Cordis ® catheter. Methods: 112 patients treated by epidural neuroplasty were included in our retrospective, non-randomized case series. The outcomes and complications of epidural neuroplasty by hydraulic and mechanical adhesiolysis in patients with chronic low back pain or nerve irritation due to nerve root compression by a single-level, contained herniated disc were assessed. A blinded investigator assessed the patients before and at 3, 6, and 12 months after treatment. Patients were asked to quantify their pain using the visual analog scale (VAS) and were also surveyed in regards to their pain medication usage. The Oswestry Disability Index (ODI) was quantified by third-party observers. Observed data at 3, 6, and 12 months after management were matched to baseline. Results: The level of pain intensity and medication usage lessened considerably in the first three months after the management. An improvement in functional status was also observed in the first 3 months. Pain scores and medication use continued to increase and functional status continued to decline in our patients over the 12-month follow-up period. There were no procedure-related complications observed. Conclusion: This retrospective study of mechanical adhesiolysis with Cordis ® catheter demonstrated a statistically significant improvement in VAS pain scores, functional status and a reduction in medication intake. These findings suggest that epidural neuroplasty can be a safe and effective procedure for selected patients. To evaluate the long-term efficacy of this minimally invasive technique, further randomized, controlled studies are required.

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Interlaminar approach for epiduroscopy in patients with failed back surgery syndrome

Abstract: We have described a new procedure for epiduroscopy with approximately 50% reduced outer diameter of the catheter, which allows interlaminar approach. Its diagnostic efficacy is clear and there were a significant number of patients who had improved outcome.

Cited by 40 publications

References 10 publications

Epiduroscopy: Complications and troubleshooting

Epiduroscopy: Complications and troubleshooting

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

Outcomes of Epidural Neuroplasty Utilizing Adhesiolysis by Means of Hydraulic and Mechanical force

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