• The Korean Journal of Pain
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• v.13 no.1
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• pp.130-133
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• 2000

Epiduroscopy is a new imaging and invasive technique that has become increasingly popular in the diagnosis and therapy of spinal pain syndrome. However, the risk of epiduroscopy is a major concern due to its invasiveness. The complications include hematoma, infection, neural damage, cardiac failure and raising of intracranial pressure. We have experienced a case of severe diffuse headache and dizziness following 1 day after epiduroscopy. Emergent brain MRI finding has no remarkable sign. The patient was admitted for 5 days to be treated with bed rest, adequate hydration and pain control with analgesics. After the treatments, she was recovered without residual sequelae and discharged. We need to take greater care of the undesirable effects detected intra- and post epiduroscopy, especially sign of increased intracranial pressure. Therefore, close monitoring of intracranial pressure is necessary during epiduroscopy.

• The Korean Journal of Pain
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• v.31 no.4
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• pp.296-304
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• 2018

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.270-273
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• 1997

Caudal epiduroscopy has been introduced as an alternative technique for direct injection of epidural steroid and lysis of adhesion. Futher, it gives a better understanding of the role of epidural adhesion in recurrence of sciatica and low back disorder after surgery. We experienced a clinical application of flexible fiberoptic epiduroscope inserted through the sacral canal. A 37-year-old woman was suffering from right lumbar radiculopathy after an operation for a herniated disc. A series of volumetric caudal steroid injections and physical therapy had little effect on her symptoms. Patient was thought to be a good candidate for epiduroscopy. Flexible flberoptic epiduroscopy was as follows: 60 ml of normal saline irrigation and epidurogram, 40 mg of triamcinolone in 10m1 of normal saline was directed around right L5 nerve root. The following morning, patient reported reduced pain in her leg.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.491-494
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• 2012

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.

• The Korean Journal of Pain
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• v.28 no.4
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• pp.275-279
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• 2015

Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.

• The Korean Journal of Pain
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• v.31 no.2
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• pp.109-115
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• 2018

Background: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. Methods: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. Results: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. Conclusions: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

• The Korean Journal of Pain
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• v.29 no.3
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• pp.151-152
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• 2016

• The Korean Journal of Pain
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• v.31 no.2
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• pp.132-134
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• 2018

• The Korean Journal of Pain
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• v.34 no.3
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• pp.371-371
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• 2021

• The Korean Journal of Pain
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• v.27 no.1
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• pp.63-67
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• 2014

Background: Epiduroscopic laser neural decompression (ELND) has been performed as a treatment tool for chronic refractory low back pain and/or radicular pain. There are some studies about the usefulness of epiduroscopy for post lumbar surgery syndrome, however, few studies about the effectiveness of epiduroscopy for patients without back surgery. We compared the satisfaction of patients who underwent ELND for chronic low back pain and/or radicular pain after back surgery and for the same symptoms without surgery. Methods: We compared the degree of satisfaction of patients after ELND between who had underwent the lumbar spine surgery and who had not retrospectively by chart reviewing. We divided 39 patients who had received ELND into two groups, one is the group of patients who got the lumbar surgery (group 1), and the other is the group of patients who did not (group 2). Their medical records including age, sex, previous treatment, duration of illness, degree of symptom relief were investigated. We compared each items between two groups. Results: The number of patients in group 1 was 17, and group 2 was 22. In group 1, 16 patients (94.1%) showed more than 'Acceptable', and 19 patients (86.4%) showed more than 'Acceptable' in group 2. There is no significant differences statistically in percentage of patients who showed more than 'Acceptable' in the satisfaction after ELND between two groups. Conclusions: ELND provided satisfaction (more than 85%) for patients with chronic low back pain and/or leg pain regardless of previous back surgery history.