scholarly journals Retinal Hemorrhage after Epiduroscopy in a Patient using Dexamethasone: A Case Report

2019 ◽  
pp. 33-36
Author(s):  
JanWillem Kallewaard
Keyword(s):  
Case Report ◽  
Epidural Space ◽  
Retinal Hemorrhage ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
Retinal Hemorrhages ◽  
First Case ◽  
Short Period ◽  
Failed Back Surgery ◽  
Back Surgery

Epiduroscopy is a minimally invasive procedure used to diagnose epidural fibrosis and to release this fibrosis; epiduroscopy is also used to precisely deposit medication into the epidural space. It is commonly used in patients who are diagnosed with failed back surgery syndrome (FBSS) after more conservative treatment has failed to provide sufficient relief of symptoms. A rare complication of epiduroscopy is retinal hemorrhaging, which is likely caused by overpressurization of the epidural space during the procedure. Patient-related risk factors for developing retinal hemorrhage after epiduroscopy remain largely unknown. This is the first case report of retinal hemorrhage in a patient using chronic dexamethasone. We describe a 73-year-old man diagnosed with FBSS who underwent epiduroscopy to diagnose and relieve epidural fibrosis. The procedure was uneventful and he was discharged from our clinic the same day, but upon routine check-up he mentioned blurry vision. Immediately he was referred to an ophthalmologist who diagnosed retinal hemorrhages in both eyes upon fundoscopic examination. Our patient was using dexamethasone for the treatment of allergies. Three months after the procedure, his vision was restored fully in the right eye and 95% in the left eye. Chronic corticosteroid use may weaken retinal veins, making them prone to rupture when there is increased pressure, even for a short period of time. Chronic use of corticosteroids must be considered a risk factor for developing retinal hemorrhages in patients undergoing epiduroscopy. Long-term use of corticosteroid can be considered as a relative contraindication for epiduroscopy. Key words: Epiduroscopy, complications, interventional pain, corticosteroids, retinal hemmorhage, failed back surgery syndrome

Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats

2004 ◽  
Vol 100 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Jin-Yul Lee ◽  
Werner Stenzel ◽  
Heinrich Ebel ◽  
Christoph Wedekind ◽  
Ralf-Ingo Ernestus ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Spinal Column ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
En Bloc ◽  
Content Type ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Epidural ◽  
Fine Print

Object. Extensive epidural fibrosis after lumbar surgery may be the underlying cause in most cases of failed—back surgery syndrome. Various materials have been used to prevent epidural fibrosis, but only moderate success has been shown. Mitomycin C, an alkylosing antibiotic substance isolated from Streptomyces caespitosus, potentially supresses fibroblast proliferation after surgery. In this study, the authors investigated the effect of mitomycin C by local application on spinal epidural fibrosis in a rat laminectomy model. Methods. Five Wistar rats underwent laminectomy at cervical, thoracic, and lumbar levels. Based on data obtained from ophthalmological studies, mitomycin C was applied to the laminectomy sites in various concentrations (0.01, 0.05, and 0.1 mg/ml). One laminectomy site in each rat was left untreated and thus served as a control. Evoked potentials were measured pre- and postoperatively, and all rats underwent clinical evaluation. Mobility status and evidence of neurological deficit were recorded. Twelve weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically. In all mitomycin C—treated laminectomy sites, epidural scarring was significantly reduced compared with control sites. Remarkably, dural adhesions were absent in laminectomy defects treated with mitomycin C concentrations of 0.05 and 0.1 mg/ml. Moderate to marked epidural fibrosis with adhesion to the dura mater was noted at sites receiving 0.01 mg/ml of mitomycin C. All control sites showed dense epidural fibrosis with marked dura adherence. Conclusions. In this experimental model, mitomycin C applied locally at a concentration of 0.1 mg/ml effectively reduced epidural fibrosis, completely avoided dural adherence, and induced no side effects.

Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 333-338
Author(s):  
Asokumar Buvanendran
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Pain Relief ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

Degenerative Osteoarthritis of the Hip Misconceived as a Failed Back Surgery Syndrome - A case report -

2008 ◽  
Vol 54 (5) ◽  
pp. 589
Author(s):  
Sang Soo Kang ◽  
Keun Man Shin ◽  
Sung Keun Nam ◽  
Hyun Cheul Kim ◽  
Il Seok Kim ◽  
...  
Keyword(s):  
Case Report ◽  
Failed Back Surgery Syndrome ◽  
Osteoarthritis Of The Hip ◽  
Degenerative Osteoarthritis ◽  
Failed Back Surgery ◽  
Back Surgery

Edema caused by continuous epidural hydromorphone infusion: A case report and review of the literature

2018 ◽  
Vol 4 (4) ◽  
pp. 255 ◽  
Author(s):  
Xiulu Ruan, MD ◽  
Riaz Tadia, MD ◽  
Hainan Liu, MS ◽  
John Patrick Couch, MD ◽  
John Keun-Sang Lee, MD, PhD
Keyword(s):  
Case Report ◽  
Infusion Pump ◽  
Failed Back Surgery Syndrome ◽  
Outpatient Setting ◽  
Leg Pain ◽  
First Case ◽  
Epidural Opioid ◽  
Failed Back Surgery ◽  
Catheter Tip ◽  
Lockout Interval

Background: Intraspinal drug delivery (IDD) therapy has been increasingly employed in patients with intractable, nonmalignant pain. Before implantation of permanent intraspinal pump, an intraspinal opioid screening trial is conducted to demonstrate the efficacy. The patient-controlled continuous epidural opioid infusion trail, performed in an outpatient setting, is widely accepted by many interventional pain specialists.Objective: To report a case of severe edema observed during the continuous epidural hydromorphone infusion trial.Case Report: An otherwise healthy 68-year-old lady with a 5-year history of severe low back pain and bilateral leg pain because of failed back surgery syndrome was referred to our clinic for IDD therapy.A tunneled lumbar epidural catheter was placed at L2- L3 with catheter tip advanced to L1 under fluoroscopic guidance. Satisfactory catheter placement was confirmed by epidurogram. The catheter was then tunneled subcutaneously and connected to a Microject™ patient-controlled epidural analgesia (PCEA) pump (Codman, Raynham, MA). The pump was programmed to deliver hydromorphone (0.1 mg/ml) at basal rate of 0.3 ml/h. The bolus dose was 0.1 ml with a 60-minute lockout interval. The patient was instructed how to operate the infusion pump. During the following infusion trial, she reported satisfactory analgesia (>70 percent pain reduction) and was able to wean off her other systemic opioids. However, she developed diffuse edema and gained over 16 pounds during the 5-day infusion trial. Her edema finally resolved 3-4 days after termination of the epidural infusion.Conclusion: Edema may occur and persist during epidural hydromorphone infusion. This report represents the first case report, to the best of our knowledge, describing severe edema in a patient on continuous epidural hydromorphone administration during an outpatient epidural infusion trial.

scholarly journals Neuromodulation in the Treatment of Postoperative Epidural Fibrosis: Comparison of the Extent of Epidural Fibrosis and the Effect of Stimulation

2021 ◽  
pp. 461-468
Author(s):  
V MASOPUST ◽  
J HOLUBOVÁ ◽  
P SKALICKÝ ◽  
R ROKYTA ◽  
J FRICOVÁ ◽  
...  
Keyword(s):  
Failed Back Surgery Syndrome ◽  
Dorsal Column ◽  
Implantation Technique ◽  
Epidural Fibrosis ◽  
Study Objective ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Lumbar Spinal ◽  
Dorsal Column Stimulation ◽  
Group 1

The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale ΔVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and ΔVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postope-rative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.

Lead extrusion ten months after spinal cord stimulator implantation: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
David Reehl ◽  
Thomas Cheriyan ◽  
Owais Qureshi ◽  
Zhuo Sun ◽  
Paramvir Singh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Rare Complication ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Failed Back Surgery ◽  
Back Surgery

AbstractObjectivesThe purpose of this case report is to describe an occurrence of a rare complication of lead extrusion, which was observed 10 months after spinal cord stimulator (SCS) implantation.MethodsA patient with low back pain and failed back surgery syndrome underwent implantation of a SCS without complications. Ten months after implantation, one SCS lead extruded from her lower back leading to surgical removal of the leads.ResultsAfter identifying the complication of a SCS lead extruding from the patient’s back, a surgical revision was performed to remove the SCS leads but retain the implantable pulse generator (IPG) in the gluteal region. During the surgery, it was noted that the anchors were in the appropriate position, sutured and fibrosed to a deep fascial layer. There were no complications from the surgical revision and no infectious process was observed.ConclusionsWe report the occurrence and management of a rare complication of SCS lead extrusion after SCS implantation for failed back surgery syndrome. After recognition, removal of the leads with retention of the IPG was able to effectively resolve the complication. The revising procedure was well tolerated but resulted in the recurrence of the patient’s previous low back pain. We believe that knowledge of this case and its management will aid future physicians in the recognition and management of this rare complication of SCS implantation. Furthermore, as there is a paucity of literature discussing the management of lead extrusion after SCS implantation, we hope that this case report will spur additional research on the management of this complication.

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