Backgraund and Aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing tretment protocol. Methods: Eighty-two patients with FBSS symtoms were included. Two groups were composed as group I (stabilized) and group II (non-stabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the Patient Satisfaction Scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were as 7.8 and 3.28 points in group I (p<0.001) and as 7.51 and 2.74 points in group II (p<0.001) at the beginning and 12th months, respectively. Mean ODI scores were as 34.05 and 22.16 points in group I (p<0.001) and as 30.74 and 19.46 points in group II (p<0.001) at the beginning and 12th months. VAS and ODI scores decreased significantly in both groups, but were more significant in non-stabilized group (p<0.001). Moderate or severe fibrous tissue was observed in 86.58% and patient satisfaction scores were very good or good in 78.06%. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the non-stabilization group, although none of these patients developed a spinal headache, and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis and the possible course of the present findings and may be more effective in unstabilized patients. Key Words: Failed back surgery syndrome, epiduroscopic adhesiolysis, hyaluronidase.
ÖzetEpidural steroid enjeksiyonu kronik bel ağrısında yaygın kullanılan bir tedavidir. Epidural steroid enjeksiyonun en sık görülen komplikasyonu, dural yırtığın eşlik ettiği yada etmediği çoğunlukla geçici olan baş ağrısıdır. Gözlenen diğer komplikasyonlar arasında; intravasküler enjeksiyon, lokal hematom, kanama, bel ağrısında artış, yüzde flushing, vazovagal reaksiyonlar, bulantı ve ateş bildirilmiştir. Bu olgu sunumunda lumber radikülopatiye bağlı kronik bel ağrısı olan hastaya uygulanan epidural steroid enjeksiyonunu takiben gelişen akut rabdomiyolizi sunduk.Anahtar sözcükler: Epidural steroid enjeksiyonu; bel ağrısı; rabdomiyoliz; serum kreatin kinaz; serum miyoglobin. SummaryEpidural steroid injection is a very common intervention in the treatment of low back pain and sciatic symptoms. The most common complication for epidural steroid injection is transient headache with or without identifiable dural puncture. Other complications have also been reported, including intravascular entry, local hematoma, bleeding, increased back pain, facial flushing, vasovagal reactions, nausea, and fever. We report a case of rhabdomyolysis following epidural steroid injection for lumbar radiculopathy.
Aims:Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.Methods:Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months.Results:The median visual analog scale score was 7.00±0.45 points before treatment and 2.73±0.65 points at 12 months post-procedure and were statistically significant (p<0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00±0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.Conclusion:Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.
Sacral Epidural Laser Discectomy (SELD) which is an effective and minimally invasive procedure for the direct visualization and therapeutic treatment of pain due to spinal disorders. The aim of this study is to share the effect of SELD on clinical findings and pain. 43 patients who had not undergone back surgery and were found to have lumbar intervertebral disc herniation at L4-5 or L5-S1 level without any indication for back surgery, and who underwent SELD for the treatment patients with low back and/or radicular pain were evaluated. Physical examination findings (the straight leg raising test (SLR) <45 degrees positive(+), SLR >45 degrees negative(-) test were accepted) and visual pain scale (VAS) values were evaluated at admission, on the same day of post-op, 1st and 6th months. Disc herniation was observed at L4-5 level in 27 patients (62.79%) and at L5-S1 level in 16 patients (37.21%). 31 patients (72.09%) benefited from SELD treatment, while surgery was recommended for 10 patients (23.26%). With SELD procedure no permanent complication was observed. The clinical response of SELD according to the lumbar disc level, a more significant improvement was found in both physical examination and VAS scores in patients with disc herniation at the L5-S1 level (p<0.001). There was no statistically significant relationship between the SLR (+) side and the outcome. SELD is a more effective option, especially in patients with good physical examination findings at admission and mild-to-moderate soft disc herniation at the L5-S1 level.
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