• The Korean Journal of Pain
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• v.18 no.2
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• pp.176-180
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• 2005

Background: Epidural steroid injections benefit certain patients with radicular pain, and often have only a limited duration. We compared the efficacy of hyaluronidase and triamcinolone and triamcinolone alone in patients with lumbar herniated disc disease treated with transforaminal epidural block. Methods: Forty patients who had undergone a transforaminal epidural injection were retrospectively reviewed. The T group received triamcinolone and local anesthetics; whereas, the HT group received hyaluronidase, triamcinolone and local anesthetics. We evaluated the improvement as being good, moderate, mild or no improvement, and in those where the improvement was good or moderate, also evaluated the duration of pain relief. Data were collected from the medical records of patients or via phone calls, which were analyzed using Student t- and chi-squared tests. A value of P < 0.05 was considered significant. Results: There were no significant differences in the degree of pain improvement or duration of pain relief between the two groups. Conclusions: A hyaluronidase and triamcinolone injection during transforaminal epidural block has on benefit with respect to the degree of pain improvement or its duration compared to a triamcinolone only injection.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.175-180
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• 2006

Background: A transforaminal epidural steroid injection has been used for the treatment of radicular arm or leg pain, which has the advantage of ventral epidural spreading compared to either an interlaminar or caudal approach. However, several factors are known to affect the epidural spread pattern of contrast dye; therefore, the injected medication can not be delivered to the target site. The objective of our study was to observe any differences in the contrast flow patterns according to several factors. Methods: A total of 34 epidurographies in 29 patients, who underwent fluoroscopically guided transforaminal epidural steroid injections, were evaluated. After confirming the location of the needle tip within the anterior superior aspect of the neural foramen in the lateral view, and at the 6 o'clock position to the pedicle in the anteroposterior view, 2 ml of contrast dye was injected. The contrast flow patterns of ventral, ventral and dorsal, and dorsal epidural filling were analyzed, according to age, gender, magnetic resonance imaging finding and history of previous back surgery. Results: Ventral contrast flow occurred in 30 out of the 34 epidurographies (88%). Both ventral and dorsal contrast flow patterns were observed 13 out of 16 (81%) patients in the older age group. Also, both ventral and dorsal contrast flow patterns were observed in 16 out of 18 (88%) patients with spinal stenosis. Conclusions: Transforaminal epidural steroid injections, performed uner fluoroscopy, provide excellent nerve root filling and ventral epidural spreading. Patients with spinal stenosis or an old age have both ventral and dorsal epidural spreading patterns.

• The Korean Journal of Pain
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• v.30 no.4
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• pp.281-286
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• 2017

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015. All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.84-88
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• 2000

Background: An increase in the maximum level of sensory blockade (MLSB) following an epidural top-up in combined spinal epidural anesthesia (CSE) may be achieved by a volume effect as the volume of local anesthetic compresses the dural sac, by a local anesthetic effect, or by a combination of both effects. This study was conducted to investigate the contribution of each of these effects. Methods: Sixty patients scheduled for lower limb surgery under CSE were randomly allocated to one of three groups of twenty patients each. Using the needle-through needle technique, all patients received a subarachnoid dose of 10 mg hyperbaric 0.5% bupivacaine. At 30 min after subarachnoid injection, an epidural top-up with saline 10 ml (group II) or 0.5% bupivacaine 10 ml (group III) was administered; patients in group I received no epidural top-up. The level of sensory blockade was assessed at 5, 10, 15, 20, 25, 30 min after subarachnoid injection and at 5, 10, 15, 20, 25, 30 min after epidural top-up. Results: There was no significant difference in the MLSB and the onset time of MLSB among group I-III. Conclusions: We concluded that the epidural top-up with saline 10 ml or 0.5% bupivacaine 10 ml which injected at 30 min after subarachnoid injection did not significantly increase the level of subarachnoid block in lower extremity surgical patients.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.181-186
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• 2006

Background: Although cervical epidural block can be a useful therapeutic treatment for head, neck and upper extremities pain, there is no consensus regarding the volume of injection required for pain management. Herein, the spreading in the vertebral segments after a cervical epidural injection of either a 5 or 10 ml volume was studied. Methods: A total of 78 patients, suffering from head, neck and upper extremity pain, were selected. Cervical epidural blocks were performed consecutively with 5 ml (n = 42) and 10 ml (n = 36) of 0.4% mepivacaine and 222 mg I/ml iopamidol at the C7⁣-T1 levels. Both anteroposterior (AP) and lateral radiographs were obtained under fluoroscopy, and the upper and lower epidural spreading of the contrast media in relation to the vertebral level was evaluated. Results: The cervical epidural blocks were performed without complications. The rostral spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.6{\pm}1.1$ and $6.1{\pm}1.1$, respectively. The caudal spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.4{\pm}3.4$ and $7.2{\pm}3.9$, respectively. The total numbers of segments with vertebral spreading of the contrast media in both directions showed significant differences between the two groups. The numbers of patients who showed spreading of the contrast media up to C2 vertebral segment showed no significant differences between the two groups. Conclusions: 5 and 10 ml epidural injection volumes may be adequate for the spread of contrast media to the entire cervical spine. A 5 ml epidural injection volume, compared to a 10 ml volume, may be ample when considering the possibility of unnecessary caudal spreading of drugs and volume related complications in the management of head, neck and upper extremity pain.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.207-212
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• 2006

Background: The epidural injection technique is a commonly used intervention in the management of chronic spinal pain, which has the advantage of delivering various drugs, such as local anesthetics or steroids, in higher concentrations to the inflamed nerve root. A guidewire-reinforced epidural catheter was introduced through a Tuohy needle during the caudal epidural procedure, with a catheter threaded into the affected nerve roots and the spread-pattern of contrast agents observed under fluoroscopy. Methods: Sixty-seven patients with low back pain, who showed evidence of a herniated nucleus pulposus on magnetic resonance imaging, were included. All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle and threaded either to the right or left side toward the target nerve roots. After confirming the catheter tip position at the affected nerve root, 2 ml increments of contrast agents (up to 6 ml) were injected, and their corresponding AP fluoroscopic views were obtained. Three radiologists reviewed all the radiographic findings and measured the proportion of the area of contrast spread at the side of target nerve roots. Results: Greater proportion of the area of contrast spread was observed at the side of the target nerve roots (P < 0.0001). At each level of contrast injection (2-⁣, 4- ⁣ and 6 ml), more than 70% of the spread of contrast dye was observed at the side of the target nerve roots in 85%, 70%, and 55% of cases, respectively. Conclusions: The combination of a caudal epidural injection and use of a guidewire-reinforced epidural catheter significantly enhances the target specificity, as revealed by the selective spread of contrast dye at the side of target nerves.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.178-182
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• 2021

Spinal hematomas are a rare but serious complication that is typically observed in the epidural space. Spinal subdural hematomas are a dangerous clinical situation because of their potential to cause significant compression of the neural elements and can be mistaken easily for spinal epidural hematomas. This paper reports a case of a severe whole lumbar subdural hematoma after a simple epidural injection that was treated with surgical decompression with excellent clinical results.

• The Korean Journal of Pain
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• v.10 no.2
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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.

• Korean Journal of Acupuncture
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• v.32 no.3
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• pp.99-107
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• 2015

Objectives : This study was designed to obtain basic data for a further large-scale trial as evaluating the efficacy and safety of Geochangmanryeung-dan(GMD) and acupuncture on patient with spinal stenosis treated by epidural steroid injection. Methods: The study is a randomized controlled pilot clinical trial, conducted over 8 weeks. Twenty participants will be recruited and randomly allocated to 2 groups: an experimental(GMD and acupuncture with epidural steroid injection) group and a control(only epidural steroid injection) group. The epidural steroid injection will be administered once per 2 weeks for 6 weeks(3 times in total). GMD will be administered as a dose of 5 pills, 3 times per day, for 6 weeks. Acupuncture will be performed 2 times per week for 6 weeks(12 times in total). The primary outcome will be measured by visual analogue scale and self-rated walking distance. The secondary outcome will be measured by PainVision, short-form McGill Pain Questionnaire, and Oswestry Disability Index. Both primary and secondary outcomes will be measured at baseline, 2, 4, 6, and 8 weeks. The last assessment(at 8 weeks) will be performed 2 weeks after treatment cessation. Conclusions : This clinical trial, as the pilot study for a future large-scale trial, will provide clinical information for evaluating the efficacy and safety of GMD and acupuncture treatment in combination with epidural steroid injection for the treatment of spinal stenosis.

• Korean Journal of Digital Imaging in Medicine
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• v.15 no.1
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• pp.21-26
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• 2013

To be investigated and measures to reduce the medical exposure of patients to change the Epidural Injection time Fluoroscopy Pulse Rate in this study. Was conducted in 50 patients who underwent surgery Epidural Injection performed by interventional care of Konkuk University Hospital from January to April 2013. The treatment time with the change of Pulse rate, is measured in minutes fluoroscopy time, and measured the area dose (${\mu}Gym^2$) and depth dose (mGy). Using the Image J program, to measure the PSNR and SNR. The fluoroscopy time as a result surgery, there was no significance in the statistical analysis, and depth dose is 34.3 to 34.9%, was reduced from 35.8 to 38.7% the area dose. It is possible to reduce the appropriate Pulse rate, to reduce the dose without statistical analysis significance fluoroscopy time.