Humans ; Epidural Abscess/etiology* ; Acupuncture Therapy/adverse effects* ; Magnetic Resonance Imaging/adverse effects* ; Epidural Space ; Spinal Diseases

OBJECTIVE: To review the clinical research progress of spinal epidural lipomatosis (SEL). METHODS: The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. RESULTS: SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. CONCLUSION SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Humans ; Decompression, Surgical/methods* ; Epidural Space/surgery* ; Lipomatosis/surgery* ; Magnetic Resonance Imaging ; Spinal Cord Diseases/surgery*

OBJECTIVE: To explore the minimally invasive surgical method for cervical_1-2 epidural neurilemmoma. METHODS: The clinical features, imaging characteristics and surgical methods of 63 cases of cervical_1-2 epidural neurilemmoma from July 2010 to December 2018 were reviewed and analyzed. Pain and numbness in occipitocervical region were the common clinical symptoms. There were 58 cases with pain, 30 cases with numbness, 3 cases with limb weakness and 2 cases with asymptomatic mass. Magnetic resonance imaging (MRI) showed that the tumors located in the cervical_1-2 epidural space with diameter of 1-3 cm. The equal or slightly lower T₁ and equal or slightly higher T₂ signals were found on MRI. The tumors had obvious enhancement. Individualized laminotomy was performed according to the location and size of the tumors, and axis spinous processes were preserved as far as possible. Resection of tumor was performed strictly within the capsule. RESULTS: Total and subtotal resection of tumor were achieved in 60 and 3 cases respectively, and no vertebral artery injury was found. The operation time ranged from 60 to 180 minutes, with an average of 92.83 minutes. The hospitalization time ranged from 3 to 9 days, with an average of 5.97 days. All tumors were confirmed as neurilemmoma by pathology. There was no postoperative infection or cerebrospinal fluid leakage. There was no new-onset dysfunction except 9 cases of numbness in the nerve innervation area. The period of follow-up ranged from 6 months to 8 years (median: 3 years). All the new-onset dysfunction recovered completely. Pain disappeared in all of the 58 patients with pain. Numbness recovered completely in 27 patients while slight numbness remained in another 3 patients. Three patients with muscle weakness recovered completely. The spinal function of all the patients restored to McCormick grade Ⅰ. No recurrence was found on MRI. No cervical spine instability or deformity was found on X-rays. CONCLUSION It is feasible to resect cervical_1-2 epidural neurilemmoma by full use of the anatomical space between atlas and axis and individual laminotomy. It is helpful to prevent cervical instability or deformity by minimizing the destruction of cervical₂ bone and preserving normal muscle attachment to cervical₂ spinous process. Strict intracapsular resection can effectively prevent vertebral artery injury.
Epidural Space/surgery* ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neoplasm Recurrence, Local ; Neurilemmoma/surgery* ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery. METHODS: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T RESULTS: The MAP at T CONCLUSION The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.
Anesthesia, General ; Electroacupuncture ; Epidural Space ; Humans ; Nerve Block ; Thoracic Surgery

This article aims to study the factors affecting the flexibility of the tip of an epidural anesthesia catheter. The flexibility of the tip of the epidural anesthesia catheter was tested with a softness tester from four aspects:raw materials, tip structure, tip processing technology, and the outer diameter of the catheter. Highly flexible and malleable polymer material with a smooth tip, the tip softening process and the proper outer diameter can effectively improve the tip flexibility of the epidural anesthesia catheter.
Anesthesia, Epidural ; Catheterization ; Catheters ; Epidural Space

INTRODUCTION: Paediatric epidurals can present technical challenges due to wide variations in age and weight among children, ranging from neonates to teenagers. This study evaluated the skin-to-epidural distance in the thoracic and lumbar regions to determine the relationship between age, weight and ethnicity and depth to the epidural space in our Singapore paediatric population. METHODS: Data from the Acute Pain Service was prospectively collected over 16 years. Details included patient demographics, level of epidural performed and distance from skin to epidural space. Multivariable regression analysis was performed to determine the association of weight, age, ethnicity and gender with the depths to the thoracic and lumbar epidural spaces. A simple linear regression was calculated to predict the depth to both thoracic and lumbar epidural spaces based on body weight. Equations were formulated to describe the relationship between weight and depth of epidural space. RESULTS: A total of 616 midline epidurals were studied. Regression analysis was performed for 225 thoracic epidurals and 363 lumbar epidurals. Our study revealed a clear correlation between skin-to-lumbar epidural distance and weight in children. The best correlation was demonstrated between skin-to-lumbar epidural distance and body weight (R = 0.729). This relationship was described by the formula: depth (mm) = (0.63 × weight [kg]) + 9.2. CONCLUSION Skin-to-lumbar epidural distance correlated with weight in children. Our results highlighted the clinical significance of differences between Southeast Asian paediatric populations when compared to other populations.
Adolescent ; Anesthesia, Epidural ; adverse effects ; methods ; Body Weight ; Child ; Child, Preschool ; Epidural Space ; anatomy & histology ; Female ; Humans ; Infant ; Infant, Newborn ; Lumbar Vertebrae ; anatomy & histology ; Male ; Multivariate Analysis ; Pain Management ; methods ; Pediatrics ; methods ; Regression Analysis ; Singapore ; Skin ; anatomy & histology ; Thoracic Vertebrae ; anatomy & histology

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.
Adult ; Arachnoid ; Blood Patch, Epidural ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid ; Diplopia ; Disease Progression ; Headache ; Humans ; Intracranial Hypotension ; Laminectomy ; Magnetic Resonance Imaging ; Membranes ; Neck Pain ; Paraparesis ; Spinal Cord ; Subarachnoid Space

Aged ; Bone Marrow ; diagnostic imaging ; pathology ; Epidural Space ; diagnostic imaging ; pathology ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; diagnostic imaging ; pathology ; Male ; Sarcoma, Myeloid ; diagnostic imaging ; pathology ; Spinal Cord Compression ; diagnostic imaging ; pathology

BACKGROUND: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. METHODS: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. RESULTS: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). CONCLUSIONS: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.
Dexamethasone ; Drug-Related Side Effects and Adverse Reactions ; Epidural Space ; Fluoroscopy ; Flushing ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Low Back Pain ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Spine ; Steroids ; Urticaria

It is difficult to distinguish Hirayama disease (HD) from other mimicking disorders in adolescent patients with distal upper limb weakness. The prevailing theory of HD postulates that the lower cervical cord is susceptible to compression during neck flexion because of insufficient growth of the dura relative to the spinal column. Confirmation of a dynamic change in the dorsal epidural space on magnetic resonance imaging (MRI) during neck flexion is essential for diagnosing HD. However, neck flexion MRI has not been routinely performed in juvenile patients with distal upper limb weakness in the absence of suspected HD. We report two cases of HD that were initially confused with other diseases because of insufficient or absent cervical flexion during MRI. Full-flexion MRI showed typical findings of HD in both cases. Our cases suggest that dynamic cervical MRI in the fully flexed position is necessary for evaluating suspected HD.
Adolescent ; Cervical Cord ; Diagnosis ; Epidural Space ; Humans ; Magnetic Resonance Imaging ; Neck ; Spinal Cord Diseases ; Spine ; Upper Extremity