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Zhong D, Wang Y, Lin L, Cheng S, Zhao GS, Wang LY, Liu Y, Ke ZY. Development and Validation of a Nomogram to Predict the Risk of Recurrent Lower Extremity Radiating Pain Within 1 Week Following Full-Endoscopic Lumbar Discectomy. World Neurosurg 2023; 179:e348-e358. [PMID: 37634669 DOI: 10.1016/j.wneu.2023.08.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Accurately predicting the risk of lower extremity (LE) radiating pain after surgery is an important endeavor for spinal surgeons. Our study aimed to identify risk factors for LE radiating pain after decompression with full-endoscopic lumbar discectomy (FELD) and develop a nomogram. METHODS We retrospectively reviewed the medical data of patients with lumbar disc herniation who underwent FELD. Two hundred thirty-five patients diagnosed at our hospital from January 2015 to December 2020 were used for model development. The independent risk factors for LE radiating pain after surgery were determined by least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis. A nomogram was developed to predict the risk of LE radiating pain based on independent risk factors. Receiver operating characteristic curve, calibration curve, and decision curve analyses were used to evaluate the predictive performance. The nomogram was further verified by an independent cohort. RESULTS Three hundred seventy-five patients were enrolled in this study, with 102 patients in the training cohort reporting LE radiating pain after FELD, while 133 patients did not. In the validation cohort, 57 patients reported LE radiating pain after FELD, while 83 patients did not. The model was established by multivariate logistic regression analysis. The risk factors included a higher Michigan State University classification of herniated discs, increased disease course, increased time of surgery, reduced lateral recess width, and an interlaminar surgical approach, compared to transforaminal approach. The C-indices and the area under the receiver operating characteristic curve of the predictive model demonstrated good discrimination. Good predictive performance and accuracy were also observed in the validation cohort. CONCLUSIONS A novel nomogram for predicting recurrent LE radiating pain within 1 week after FELD was established and validated. More aggressive pain management strategies should be considered for patients at high risk of LE radiating pain after surgery, as predicted by this model.
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Affiliation(s)
- Dian Zhong
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lu Lin
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Cheng
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guo Sheng Zhao
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yuan Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen Yong Ke
- Department of Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Vladimir Guauque C, Pérez Anillo RD, Mesa Oliveros A. Manejo de adherencias epidurales y dolor lumbar crónico posquirúrgico con epiduroscopia. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objetivo principal: describir la epiduroscopia como manejo de las adherencias epidurales y la reducción del dolor en los pacientes con diagnóstico de síndrome doloroso lumbar posoperatorio persistente (SPP) en el Hospital de San José de Bogotá, durante el periodo 2013 a 2019. Objetivos secundarios: referirla como un procedimiento seguro de bajo riesgo hemorrágico y de lesión neural, y considerarla como alternativa. Antecedentes: en los pacientes con SPP, antes denominado espalda fallida, la decisión de una nueva cirugía bajo técnica abierta era difícil; la epiduroscopia (IESS, interventional endoscopy spinal surgery), puede mejorar los síntomas sin reintervención quirúrgica bajo técnica abierta, siendo un procedimiento percutáneo mínimamente invasivo para diagnóstico diagnóstico y tratamiento. Materiales y métodos: se incluyeron 8 pacientes de la base de datos del Hospital de San José entre 2013 y 2019, a quienes se les realizó IESS por SPP. Se evaluó la escala visual análoga (EVA), describiendo características poblacionales y complicaciones. Resultados: 75% presentaron EVA menor de 7.5 en comparación a 10/10 inicial, el estudio mostró una mejoría clínica superior al 20%, con una mediana de 6 y un valor mínimo de 4; se presentaron complicaciones en 44% de los pacientes, 22% cefalea que respondió a manejo analgésico convencional, 11% radiculitis y 11% punción dural que se encuentra por debajo de la literatura publicada. Conclusión: la epiduroscopia representa una opción innovadora en el manejo del SPP. Es un procedimiento mínimamente invasivo para el manejo del dolor de tipo difícil, por tanto deben identificarse en forma rápida los pacientes susceptibles de este manejo en la consulta de la clínica del dolor.
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Marchesini M, Baciarello M, Bellacicco R, Flaviano E, Bignami EG. 24-Month Effectiveness of Periduoscopic Adhesiolysis in Reducing the Use of Spinal Cord Stimulation in Patient With Chronic Lumbar Pain: A Possible Therapeutic Regimen? Cureus 2021; 13:e17563. [PMID: 34513528 PMCID: PMC8410131 DOI: 10.7759/cureus.17563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Epiduroscopy is a minimally invasive procedure that is used in pain therapy to treat lumbar and root pain that is resistant to medical and infiltrative therapies. The indications for periduroscopy are partly shared with those of spinal cord stimulation (SCS): failed back surgery syndrome (FBSS) and stenosis of the vertebral canal in particular. The costs and risks of periduroscopy are considerably lower than those of SCS. The purpose of this study is to evaluate the clinical and economic advantages of integrating periduroscopy as a step prior to SCS for patients with severe lumbar or radicular pain that is unresponsive to pharmacological and infiltrative treatments. Materials and Methods Patients were enrolled if they had FBSS and spinal stenosis with indications for SCS and accepted periduroscopy treatment before the possible SCS trial. Patients were followed up for 24 months with evaluations of clinical data on the day after the procedure and at one and 24 months. The pain trend, satisfaction with the periduroscopy procedure, and the incidence of SCS implants in the study period were analyzed. Results A total of 106 patients were enrolled. Immediately after the procedure and in the first month, the reduction of pain and the level of patient satisfaction were high, but they were drastically reduced at 24 months with a progressive reappearance of symptoms that substantially overlapped with the pre-surgery levels. At 24 months, 48% of the patients underwent a neurostimulation trial, and a significant percentage of them were able to avoid the implantation of an SCS. Conclusions Periduroscopy appears to be rational as a step prior to SCS in terms of the improvement of pain symptoms in the short term, the definitive results in a significant percentage of patients, and the significant economic savings for the health system.
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Affiliation(s)
- Maurizio Marchesini
- Anesthesia and Critical Care, Instituti Clinici Scientifici (ICS) Maugeri, Pavia, ITA
| | - Marco Baciarello
- II Service Anesthesia, Critical Care and Pain Medicine, Azienda Ospedaliero Universitaria Parma, Parma, ITA
| | - Roberto Bellacicco
- II Service Anesthesia, Critical Care and Pain Medicine, Azienda Ospedaliero Univeristaria Parma, Parma, ITA
| | - Edoardo Flaviano
- Anesthesia and Critical Care, Papa Giovanni XXIIII, Bergamo, ITA
| | - Elena G Bignami
- II Service Anesthesia, Critical Care and Pain Medicine, Azienda Ospedaliera Universitaria Parma, Parma, ITA
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Rapčan R, Kočan L, Mláka J, Burianek M, Kočanová H, Rapčanová S, Hess M, Hammond A, Griger M, Venglarčík M, Gajdoš M, Vašková J. A Randomized, Multicenter, Double-Blind, Parallel Pilot Study Assessing the Effect of Mechanical Adhesiolysis vs Adhesiolysis with Corticosteroid and Hyaluronidase Administration into the Epidural Space During Epiduroscopy. PAIN MEDICINE 2020; 19:1436-1444. [PMID: 29584916 DOI: 10.1093/pm/pnx328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Epiduroscopy is a proven method of diagnosis and treatment for chronic radicular pain after spinal surgery, which is known as failed back surgery syndrome (FBSS). The aim of the study was to compare the efficacy of drugs (the enzyme hyaluronidase and corticosteroid DEPO-Medrol) administrated into the epidural space during epiduroscopy, performed within the ventral and ventro-lateral epidural space with a focus on releasing foraminal adhesions. METHODS Forty-eight patients with diagnosed FBBS were randomized into two groups before epiduroscopy. Group A received the standard treatment-mechanical lysis of fibrotic tissue in the epidural space. Group B received hyaluronidase and corticosteroid methylprednisolone acetate during the procedure. Subjects were followed for six and 12 months via scheduled double-blinded examinations by pain physicians. Leg and back pain intensity was assessed by an 11-point numerical rating scale, and patients' functional disability was assessed by the Oswestry Disability Index (ODI). RESULTS Study subjects showed a significant decrease in ODI score in both groups (P < 0.05). Significantly lower pain scores for leg pain (P < 0.05) and back pain (P < 0.05) were also recorded after the six-month follow-up. However, the one-year follow-up showed a return to the baseline ODI values of most monitored pain scores in both groups (P > 0.05). Improvement was only noted on the NRS for back pain at one-year follow-up (P < 0.05). CONCLUSIONS A significant improvement of leg and back pain was found in both groups after six months. ODI was significantly improved only in group B in both the six- and 12-month intervals. Back pain at one-year follow-up was only improved in group B.
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Affiliation(s)
- Róbert Rapčan
- Europainclinics, Prague, Czech Republic.,Europainclinics, Nové Mesto, Slovak Republic.,Europainclinics, Bardejov, Slovak Republic
| | - Ladislav Kočan
- Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Košice, Slovak Republic
| | - Juraj Mláka
- Europainclinics, Poliklinika Terasa, Košice, Slovak Republic
| | | | - Hana Kočanová
- Clinic of Anaesthesiology and Intensive Care Medicine, Railway Hospital and Clinic Košice, Košice, Slovak Republic
| | | | | | | | | | | | - Miroslav Gajdoš
- Department of Neurosurgery, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, and Louis Pasteur University Hospital, Košice, Slovak Republic
| | - Janka Vašková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
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Yang H, Li P, Jia N, Wang J, Jin X. [Comparison of different transforaminal endoscope approaches in treatment of serious lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:300-307. [PMID: 32174073 DOI: 10.7507/1002-1892.201811005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation. Methods Between October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups ( P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness. Results The removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm 3, respectively. There were significant differences between groups ( P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation ( P<0.05); there was no significant difference in the scores and improvements between groups after operation ( P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation ( P<0.05); there was no significant difference between groups ( P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation ( P>0.05); and there was no significant difference in LCI and loss value between groups ( P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value ( P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up ( P>0.05). Conclusion Application of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.
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Affiliation(s)
- Hu Yang
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Pengfei Li
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Nan Jia
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Jinxing Wang
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Xianhui Jin
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
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State-of-the-Art Diagnostic Methods to Diagnose Equine Spinal Disorders, With Special Reference to Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation. J Equine Vet Sci 2019; 81:102790. [PMID: 31668311 DOI: 10.1016/j.jevs.2019.102790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022]
Abstract
Spinal cord disorders are a common problem in equine medicine. However, finding the site of the lesion is challenging for veterinarians because of a lack of sensitive diagnostic methods that can assess neuronal functional integrity in horses. Although medical imaging is frequently applied to help diagnose corticospinal disorders, this approach does not reveal functional information. For the latter, transcranial magnetic stimulation (TMS) and more recently transcranial electrical stimulation (TES) can be useful. These are brain stimulation techniques that create either magnetic or electrical fields passing through the motor cortex, inducing muscular responses, which can be recorded either intramuscularly or extramuscularly by needle or surface electrodes. This permits the evaluation of the functional integrity of the spinal motor tracts and the nerve conduction pathways. The interest in TES in human medicine emerged these last years because unlike TMS, TES tends to bypass the motor cortex of the brain and predominantly relies on direct activation of corticospinal and extrapyramidal axons. Results from human medicine have indicated that TMS and TES recordings are mildly if not at all affected by sedation. Therefore, this technique can be reliably used in human patients under either sedation or full anesthesia to assess functional integrity of the corticospinal and adjunct motor tracts. This opens important new avenues in equine medicine.
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8
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Abstract
Degeneration, whether from age or postsurgical, in the ventral and lateral epidural space can lead to irritation of both the nerve roots and of the nerves present in the epidural space, the peridural membrane and the posterior longitudinal ligament. This irritation is often accompanied by mild scarring. Neuroplasty is a specific procedure designed to relieve this irritation. The effectiveness of neuroplasty is not affected by the extent of spinal stenosis. Neuroplasty can be performed in the lumbar, thoracic and cervical spine, and using caudal, transforaminal and interlaminar approaches. Postprocedural home exercises are an integral part of the procedure. There are multiple high-grade studies positive for the effectiveness and safety of neuroplasty. Neuroplasty should be offered prior to surgery in patients with persistent back and/or extremity pain.
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Affiliation(s)
- Standiford Helm
- The Helm Center for Pain Management, Laguna Woods, CA 92637, USA
| | - Nebojsa Nick Knezevic
- Vice Chair for Research & Education, Department of Anesthesiology & Pain Management, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Clinical Associate Professor, Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
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9
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Suzuki T, Inokuchi R, Hanaoka K, Suka M, Yanagisawa H. Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study. SAGE Open Med 2018; 6:2050312118756804. [PMID: 29449944 PMCID: PMC5808957 DOI: 10.1177/2050312118756804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 01/09/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.
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Affiliation(s)
- Takashi Suzuki
- Department of Anesthesiology and Pain Relief Center, JR Tokyo General Hospital, Tokyo, Japan.,Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Tokyo, Japan.,Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuo Hanaoka
- Department of Anesthesiology and Pain Relief Center, JR Tokyo General Hospital, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Jo DH. Epiduroscopy as a Diagnostic Tool for the Lower Back Pain and/or Leg Pain. Korean J Pain 2016; 29:151-2. [PMID: 27413478 PMCID: PMC4942641 DOI: 10.3344/kjp.2016.29.3.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dae Hyun Jo
- Pain Center, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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Shrauner B, Blikslager A, Davis J, Campbell N, Law M, Lustgarten M, Prange T. Feasibility and safety of lumbosacral epiduroscopy in the standing horse. Equine Vet J 2016; 49:322-328. [DOI: 10.1111/evj.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. Shrauner
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - A. Blikslager
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - J. Davis
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - N. Campbell
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Law
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Lustgarten
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - T. Prange
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
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12
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Prange T, Shrauner BD, Blikslager AT. Epiduroscopy of the lumbosacral vertebral canal in the horse: Technique and endoscopic anatomy. Equine Vet J 2015; 48:125-9. [DOI: 10.1111/evj.12470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Affiliation(s)
- T. Prange
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - B. D. Shrauner
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - A. T. Blikslager
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
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13
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Bosscher HA, Heavner JE. Treatment of Common Low Back Pain: A New Approach to an Old Problem. Pain Pract 2014; 15:509-17. [DOI: 10.1111/papr.12224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/28/2014] [Accepted: 04/15/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Hemmo A. Bosscher
- Department of Anesthesiology; Texas Tech University Health Sciences; Lubbock Texas U.S.A
| | - James E. Heavner
- Department of Anesthesiology; Texas Tech University Health Sciences; Lubbock Texas U.S.A
- Department of Cell Physiology and Molecular Biophysics; Texas Tech University Health Sciences Center; Lubbock Texas U.S.A
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14
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Hidalgo B, Hall T, Nielens H, Detrembleur C. Intertester Agreement and Validity of Identifying Lumbar Pain Provocative Movement Patterns Using Active and Passive Accessory Movement Tests. J Manipulative Physiol Ther 2014; 37:105-15. [DOI: 10.1016/j.jmpt.2013.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 09/10/2013] [Accepted: 09/20/2013] [Indexed: 11/25/2022]
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15
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Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural lysis of adhesions. Korean J Pain 2014; 27:3-15. [PMID: 24478895 PMCID: PMC3903797 DOI: 10.3344/kjp.2014.27.1.3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 11/05/2022] Open
Abstract
As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.
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Affiliation(s)
- Frank Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - David E. Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Robert W. Hurley
- Department of Anesthesiology, Neurology, Psychiatry & Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA
| | - Steven P. Cohen
- Department of Anesthesiology and Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, and Walter Reed National Military Medical Center, Baltimore, USA
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Bosscher HA, Heavner JE. Lumbosacral epiduroscopy findings predict treatment outcome. Pain Pract 2013; 14:506-14. [PMID: 24118805 DOI: 10.1111/papr.12112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/29/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the significance of diagnostic markers obtained through epiduroscopy by evaluating the accuracy of outcome prediction after treatment of epidural pathology using epiduroscopy. DESIGN A prospective observational study of 139 patients was performed. Patients with chronic low back and leg pain were included. Of the 150 patients who underwent epiduroscopy in the year 2008 at a US hospital, 139 were available for evaluation at 1 month. STUDY Outcome of treatment was predicted based on direct visual information (hyperemia, vascularity, and fibrosis) and mechanical information (pain to touch, contrast spread, and patency) obtained through epiduroscopy. MAIN OUTCOME MEASURES Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios. RESULTS A prediction of outcome was made in 114 of 139 patients (82%). This prediction was correct in 89 of these 114 patients (accuracy of 78%). The sensitivity and specificity of epiduroscopy with respect to the prediction of outcome were 75% and 82%, respectively. These results were statistically significant (P < 0.01). In 25 of the 139 patients (18%), discrete epidural pathology was not observed. Nine of these 25 patients reported good relief after epiduroscopy. The sensitivity and specificity of epiduroscopy in the diagnosis of epidural pathology were 91% and 39%, respectively. These results were not statistically different (P > 0.1). CONCLUSION Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value.
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Affiliation(s)
- Hemmo A Bosscher
- Departments of Anesthesiology, Texas Tech University Health Sciences, Lubbock, Texas, U.S.A
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Vanelderen P, Van Boxem K, Van Zundert J. Epiduroscopy: the missing link connecting diagnosis and treatment? Pain Pract 2012; 12:499-501. [PMID: 22891852 DOI: 10.1111/j.1533-2500.2012.00587.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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