• The Korean Journal of Pain
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• 제10권2호
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• pp.214-219
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• 1997

Background: Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatment of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging(MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adhesiolysis in patients with low back pain. Methods: We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesion site under fluoroscopic guidance. Injection of contrast dye was achieved and prospected spread of agents. Injection of 0.25% bupivacaine, triamcinolone, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 months. We also looked for complication of epidural adhesiolysis. Results: Statistical analysis(Friedman nonparametric repeated measures test and Dune's multiple comparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis(P<0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P<0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappeared after a few months without residual sequelae. Conclusion: We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibrosis and adhesion. A direct visualization by epiduroscopy may be more useful to the resulting functional changes after epidural adhesiolysis.

• The Korean Journal of Pain
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• 제13권1호
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• pp.74-78
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• 2000

Background: Epidural Adhesiolysis is an interventional pain management technique for patients with low back pain. In addition to local anesthetics and corticosteroid, hypertonic saline (NaCl) are used for the technique. Present study was aimed to compare analgesic and adverse effects of two different concentration of hypertonic saline in Epidural Adhesiolysis. Methods: Fifty-three subjects with low back pain with radiculopathy were assigned to one of two epidural adhesiolysis treatment groups: 8% (Group I, n=26) or 10% (Group II, n=27) hypertonic saline. 17 G epidural needle was inserted at sacral hiatus and catheter was advanced untill its tip was located at lesion site under fluoroscopic guidance. Subjects in all treatment groups received epidural corticosteroid and local anesthetic. And then, hypertonic saline injection via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) at post-epidural adhesiolysis 1, 2, 3 days, 1 week, and 1, 3 months. We also looked for complications of epidural adhesiolysis at different concentration of hypertonic saline. Results: Statistical analysis demonstrated that NRS was not significantly different between two groups during 3 months after epidural adhesiolysis. There were no major differences of complications between two groups and disappeard after a few months without residual sequelae. Conclusions: We conclude that epidural adhesiolysis using 8% hypertonic saline is effective for relief of low back pain with proven lumbosacral fibrosis without any residual sequelae compared with 10%.

• The Korean Journal of Pain
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• 제22권3호
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• pp.245-248
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• 2009

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.