Visual Impairment Following Epidural Fluid Injections and Epiduroscopy: A Review

Gill, J. Brian; Heavner, James E.

doi:10.1111/j.1526-4637.2005.00062.x

Cited by 76 publications

(64 citation statements)

References 30 publications

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“…1,2 Although epiduroscopy has been considered to be a safe procedure in experienced hands, severe complications such as retinal bleeding with visual impairment 3 and epidural abscess 4 have been occasionally reported. Iotrolan, a nonionic water-soluble radiographic contrast medium, has often been used for epidurography.…”

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confidence: 99%

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Mizuno

Gauss

Suzuki

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: We describe a complication of epiduroscopy with encephalopathy and rhabdomyolysis associated with the contrast medium iotrolan. Clinical features:A 76-yr-old man with failed back surgery syndrome underwent epiduroscopy. Sufficient lysis could not be achieved in the epidural space above the level of L 4 due to dense adhesions and scar tissue. After epidural injections of iotrolan and mepivacaine, he developed motor weakness and hypoesthesia in both legs, which lasted for three hours. He also became confused, agitated, disoriented, and developed neck stiffness and tremors involving the head and legs. Computed tomography revealed diffuse contrast enhancement within the intracranial cerebrospinal fluid (CSF) spaces, indicating an intraoperative dural tear. Marked increases in serum creatinine phosphokinase and myoglobin indicated subsequent acute rhabdomyolysis. Crystalloid infusion and semi-recumbent positioning facilitated iotrolan absorption from the CSF, and the patient recovered uneventfully. Conclusions:Dural tear during epiduroscopy may allow access of contrast media into the CSF. Neurotoxicity secondary to iotrolan within the CSF was a likely contributing factor to the encephalopathy and subsequent rhabdomyolysis. This is an instructive example of the importance of diagnosing inadvertent dural tear during epiduroscopy under iotrolan, for avoidance of adverse events such as encephalopathy and rhabdomyolysis. Eléments cliniques : Un homme de 76 ans présentant des séquelles d'un échec d'une chirurgie aux rachis a subi une épidur-oscopie. Une lyse suffisante n'a pas pu être obtenue dans l'espace péridural au-dessus de L 4 à cause d'adhésions denses et de tissus cicatriciels. Suite à des injections péridurales d'iotrolan et de mépivacaïne, il a développé une parésie ainsi qu'une hypoesthésie au niveau des membres inférieurs qui durèrent trois heures. Il est également devenu confus, agité, désorienté, et a développé une raideur du cou et des tremblements de la tête et des jambes. La tomodensitométrie a révélé un rehaussement diffus du produit de contraste dans les espaces intracrâniens du liquide céphalo-rachidien (LCR), indiquant

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confidence: 99%

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Mizuno

Gauss

Suzuki

et al. 2007

Can J Anesth/J Can Anesth

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“…En el análisis de los estudios, en los cuales se analizó la inyección epidural de esteroides dirigida por epiduroscopia, encontramos dos estudios de alta relevancia epidemiológica (17,18) y un estudio en el cual se realizó una revisión sobre una complicación poco frecuente pero altamente incapacitante, el deterioro visual posterior a epiduroscopia (19). A continuación se ilustran los desenlaces y resultados de los diferentes estudios incluidos en el análisis de este punto.…”

Section: Inyección Epidural De Esteroides Dirigida Por Epiduroscopiaunclassified

“…Sin embargo, en el análisis estadístico de los resultados reportan disminución significativa del puntaje en la EVA únicamente a los 3 y 12 meses. Por último, en el trabajo publicado por Gill y Heavner (19) se realizó una búsqueda en una única base de datos (PubMed) sobre reportes de caso de alteraciones visuales ("visual impairment") posterior a la realización de procedimientos con endoscopia epidural. Al momento de la publicación del estudio (2005), se encontraron 12 reportes de caso.…”

Section: Inyección Epidural De Esteroides Dirigida Por Epiduroscopiaunclassified

Técnicas de epiduroscopia en el tratamiento del dolor lumbar: una revisión sistemática de la literatura

Harker

Acevedo

2016

Rev. Soc. Esp. Dolor.

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Rev Soc Esp Dolor 2016; 23(4): 191-201Recibido: 20-07-15. Aceptado: 21-09-15.Harker P y Acevedo JC. Técnicas de epiduroscopia en el tratamiento del dolor lumbar: una revisión sistemática de la literatura. Rev Soc Esp Dolor 2016;23(4):191-201. ABSTRACTObjectives: Low back pain is one of the most complex benign pathologies in terms of treatment cost and effectiveness. In the present study we evaluate the usefullness of epiduroscopy en treating low back pain and its benefit over traditional percutanoeus techniques Materials and methods: We carried out a sistematic search in 4 digital databases, PubMed, Embase, Cochrane and Medline. The search was limited to articles published between January 1990 and June 2014. Only clinical studies (both observational and experimental) were included.Results: We obtained 353 articles after a thorough search in all 4 databases of which only 78 met inclusión and exclusión criteria. These 78 articles were then critically reviewed by independent peers following standardized parameters. Twenty-four (24) articles were included in the review. Most of the articles (14) evaluated adhesiolysis and epidural injections, three studies evaluated directed epidural injections alone and the remaining articles were either alternate sistematic reviews or evaluated other interventions.Conclusions: Epidurosopy is a useful tecnique in the treatment of low back pain with statistically significant differences in the long-term results in select patients. Results are best in patients with persisting symptoms after spinal fusion and in patients whose symptoms are radicular and not axial or unspecific.Key words: Epidural endoscopy, epidural injections, low back pain, adhesiolysis. RESUMENObjetivo: El dolor lumbar es una de las patologías más complejas en términos de costo-efectividad de los tratamientos. En este estudio evaluamos la utilidad de la epiduroscopia en el manejo de dolor lumbar, y su beneficio en comparación con las técnicas percutáneas tradicionales.Materiales y métodos: Se realizó una búsqueda de manera sistemática en las bases de datos PubMed, EMBASE, Cochrane y MedLine para artículos publicados entre enero de 1990 y diciembre de 2013. Se incluyeron estudios clínicos descriptivos y experimentos clínicos aleatorizados, excluyéndose estudios no clínicos, opiniones de expertos, etc.Resultados: Se obtuvieron 353 artículos en las 4 bases de datos, de los cuales sólo 78 pasaron el corte según criterios de exclusión e inclusión. Posteriormente se realizó un análisis críti-co de los artículos según parámetros estandarizados. De los 78 artículos evaluados, se incluyeron 24 en la revisión final, 14 estudios evaluaron lisis de adherencias e inyección de esteroides, 3 estudios evaluaron la efectividad de la inyección epidural dirigida por epiduroscopia, mientras que los 7 restantes evaluaron otras intervenciones.Conclusiones: La epiduroscopia es una tecnología útil en el tratamiento del dolor lumbar con diferencias significativas en los resultados a largo plazo en ciertos pacientes. Esta tecnología es...

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“…It is reported by Gill and Heavner [51] that a sudden increase in epidural pressure due to the epidural infusion causes compression of the optic nerve and compression of the vessels that results to a rupture and in turn to retinal haemorrhage. Another clinically relevant complication described by Mizuno et al [46] in which encephalopathy and rhabdomyolysis was induced by the administration of the contrast agent iotrolan during epiduroscopy.…”

Section: Complicationsmentioning

confidence: 99%

Epiduroscopy (Epidural Endoscopy)

Sayhan¹,

Beyaz²

2016

Pain Management

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Epiduroscopy is a relatively new technique used in the evaluation and treatment of low back pain via advancements in optical fiber technology. As a minimally invasive endoscopic technique, it allows for direct endoscopic imaging of the epidural space and helps the patients for the pain management who having post-lumbar surgery syndrome (PLSS) and other cases of low back pain and radiculopathy. An advanced understanding of the anatomy of epidural space and adjacent structures are also essential for positive and successful clinical outcomes. The use of epiduroscopy in the pain clinic is performed as a day procedure, and the patient is awake and can communicate with the doctor. During an epiduroscopy, thin tubes with a bright light and tiny fiberoptic camera at the end are inserted through the sacral hiatus into the epidural space around the dura and guided up toward the affected site. Anterior epiduroscopy and epiduroscopic laser neural decompression (ELND) have been recently introduced in treating herniated disc decompressions, and chronic low back pain and radicular pain, respectively. The most common complications of epiduroscopic approach are the pain in the intervention point, dural puncture, and headache.

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Visual Impairment Following Epidural Fluid Injections and Epiduroscopy: A Review

Cited by 76 publications

References 30 publications

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Técnicas de epiduroscopia en el tratamiento del dolor lumbar: una revisión sistemática de la literatura

Epiduroscopy (Epidural Endoscopy)

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