• The Korean Journal of Pain
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• v.8 no.2
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• pp.279-285
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• 1995

Extradural block is a form of treatment described as early as the beginning of the present centuries. It has since had positive criticism from a number of authors in different countries. Epidural injections of steroids with or without local anesthetic have become an occasional method of conservative treatment in sciatica & lumbago, especially in acute case. We assess the results of continuous epidural block with steroids and local anesthetics in sciatica & lumbago. From July 1994 to June 1995, we treated 46 case of lumbago and sciatica using continuous epidural block with steroids and local anesthetics. After placement of 17-Gauge Tuohy needle in the epidural space by the technique of loss of resistance, 0.25% bupivacaine 5 cc and triamcinolone 40 mg was administered and then epidural catheter was placed and connected to multiday infusor(Paragon) using 1% lidocaine with continuous infusion rate of 1 ml/hour. Usually, the catheter was removed after 1~2 weeks and then treated with the physical therapy. At the time of patient's discharge, 69.5% of all cases showed excellent or good results. Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using continuous epidural block procedure, a relief in symptoms showed in 65.5% of these 26 cases. Continuous epidural block provides shortening of the recovery time from pain, avoidance of long period bed rest and early physical therapy and exercise. Therefore, continuous epidural block is simple and safe in the treatment of lumbago and sciatica, especially in acute phase.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.134-138
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• 2011

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.144-147
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• 2015

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.131-135
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• 2000

Spontaneous spinal epidural hematoma, an idiopathic accumulation of blood in the vertebral epidural space without identifiable predisposing factors, is a rare condition. The diagnosis can be made from a careful history and neurological examination, but clinical diagnosis is often difficult because of its non-specific symptomatology and it can be confused with myocardial infarct, musculoskeletal pain, vasculitis and acute dissection of an aortic aneurysm. For a favourable outcome, early decompressive laminectomy and evacuation of hematoma are necessary. We report a 50-year-old female who presented with acute paraparesis and back pain on thoracic area. Diagnosis of spinal epidural hematoma which extended over $T_4-T_9$ was made by magnetic resonance imaging. We performed immediately decompressive laminectomy and evacuated the epidural hematoma. No cause for bleeding was evident. Postoperatively, neurological symptoms disappeared within six weeks.

• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.376-378
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• 2015

Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.87-90
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• 1988

In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice It is still subject to certain drawbacks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketamine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30% of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratory depression, and there no postoperative neurologic sequelae. The present results indicated the need for further studies to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of postoperative pain.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.288-291
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• 2006

Epidural analgesia using an epidural catheter is an effective method to relieve the pain during the rehabilitating procedure for postoperative orthopedic patients. Total spinal anesthesia is one of the possible complications of epidural catheterization which can lead to a life-threatening condition. Achondroplasia is the most common form of short-limbed dwarfism resulting from a failure of endochondral bone formation. In patients suffering with short stature syndrome like achondroplasia, the incidence and risk of total spinal anesthesia during epidural anesthesia may increase because of the technical difficulty and structural anomaly of the spine. We report here on a 35-year old female patient with a height of a 115 cm. She was diagnosed as achondroplasia and she had a previous Ilizarov operation; both tibial lengthening and correction of valgus were done. No specific event occurred during epidural catheterization. Immediately after the injection of a test dose via epidural catheter, the patient became hypotensive, drowsy and showed weakness of both her upper and lower extremities. The symptoms were disappeared after 40 minutes. The catheter was removed on the next day. We concluded that the total spinal anesthesia was caused by intrathecal injection of local anesthetics through the epidural catheter, and the anesthesia then migrated into the subarachonoid space.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.403-405
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• 2010

A rare case of solitary intraspinal epidural lymphangioma is described with a review of the literature. A 16-year-old boy was admitted to our hospital with a history of two-year of progressive paraparesis. Magnetic resonance imaging study revealed a $2{\times}2{\times}6$ cm sized epidural cystic mass in the thoracic spine. Surgical total removal and biopsy were performed. The final pathologic report on the mass indicated lymphangioma.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.130-133
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• 2011

Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.207-210
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• 2001

Backgroud: Caudal blocks have been used for pain management in outpatient clinics. It is important to estimate the proper depth and angle in order to increase the success rate of the procedure. Methods: Data was collected from 60 patients who visited our pain clinic. We measured the depth of the needle's penetration and the angle of the needle at the insertion point when a caudal approach was confirmed by air flow method. We recorded age, sex, body weight and height, and calculated the ponderal index. Results: The depth from the skin to the caudal epidural space was a mean 2-4 cm ($3{\pm}0.4\;cm$). The angle at the needle insertion point was a mean 15-50 degree ($34.9{\pm}6.8$ degree). Conclusions: If we use the mean depth and angle as a guide, complications during the caudal epidural procedure can be avoided.