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 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

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

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.
Brain Diseases ; Cicatrix ; Epidural Space ; Failed Back Surgery Syndrome ; Hearing Loss ; Humans ; Inflammation ; Leg ; Low Back Pain ; Paresthesia ; Pharmaceutical Preparations ; Pneumocephalus ; Post-Dural Puncture Headache ; Punctures ; Retinal Hemorrhage ; Rhabdomyolysis ; Seizures ; Tears ; Tissue Adhesions ; Urinary Bladder, Neurogenic ; Vision Disorders

Epidural neuroplasty is a treatment modality for back pain and/or radiating pain caused by mechanical compression or neural inflammation of intra-spinal neural structures. Since epidural neuroplasty was first introduced as a treatment for pain caused by epidural adhesion such as failed back surgery syndrome (FBSS), it has been performed as a treatment for many kinds of pain of spinal origin including acute/chronic herniation of intervertebral disc, radiculopathy, spinal stenosis, FBSS, epidural adhesion, vertebral compression fracture, vertebral metastasis, resistant multilevel degenerative arthritis, epidural scar pain by infection or meningitis, and whiplash injury. Epidural neuroplasty is a catheterization technique used to treat back pain and/or radiating pain by injecting therapeutic drugs into lesions of epidural space shown as a filling defect in epidurogram. Usually, normal saline, local anesthetics, and steroid are used as therapeutic drugs. The exact mechanisms of action of the procedure are unknown but include 2 postulated mechanisms of action for pain relief. i.e., mechanical adhesiolysis by volume effect and chemical adhesiolysis by injected drugs. Relative large volumes of normal saline injection resolve adhesions and wash out accumulated pain substances; local anesthetics are used for stabilization and analgesia of flaring neural structures and for pain management for procedure related pain; and steroid is used for the treatment of inflammation of neural and peri-neural structures. The resolution of filling defect can be verified by post-procedure epidurogram. The key point of epidural neuroplasty for good results, is the exact localization of the epidural catheter into the epidural lesion.
Analgesia ; Anesthetics, Local ; Back Pain ; Catheterization ; Catheters ; Cicatrix ; Epidural Space ; Failed Back Surgery Syndrome ; Fractures, Compression ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Displacement ; Meningitis ; Neoplasm Metastasis ; Osteoarthritis ; Pain Management ; Radiculopathy ; Spinal Stenosis ; Whiplash Injuries

Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS), which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants, chemicals and low dose radiation. However, most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat, ADCON-L, and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility, degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia, less side effects and long half-life. Besides, the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion.
Biocompatible Materials ; administration & dosage ; Epidural Space ; pathology ; Humans ; Laminectomy ; adverse effects ; Lumbar Vertebrae ; surgery ; Tissue Adhesions ; prevention & control

PURPOSE: DepoDur(R) is a single-dose extended-release morphine injection into the epidural space. It is not commonly used, but has many advantages over traditional analgesic regimens. We analyzed a number of these advantages in our case series in the context of the colorectal enhanced recovery program (ERP) and aimed to show that the ERP could be further enhanced by using DepoDur(R). METHODS: We conducted a prospective audit of all patients undergoing open and laparoscopic colorectal procedures where DepoDur(R) was used between July 2010 and April 2012. Validated pain scores were used, and primary outcome measures were resting and dynamic pain, mobilization, and need for additional analgesia. RESULTS: Two hundred eighty patients were included in the case series. Good pain control was seen at 24 and 48 hours. Eighty-one percent of the patients required simple analgesia alone at 24 hours, and 62% required simple analgesia (paracetamol +/- nonsteroidal anti-inflammatory drugs) alone at 48 hours. Only a minority required additional oramorph and patient-controlled analgesia at 24 and 48 hours (19% at 24 hours and 38% at 48 hours). Seventy-nine percent of the patients were mobilized at 24 hours, and 88% of the patients were mobilized at 48 hours. CONCLUSION: DepoDur(R) is an effective alternative to conventional pain management techniques and may have a role in further enhancing the ERP.
Analgesia ; Analgesia, Patient-Controlled ; Colorectal Surgery* ; Epidural Space ; Humans ; Morphine* ; Outcome Assessment (Health Care) ; Pain Management ; Postoperative Period ; Prospective Studies

Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.
Adult ; Aged ; Amides/administration & dosage ; Anesthetics, Local/administration & dosage ; Anti-Inflammatory Agents/administration & dosage ; Cervical Vertebrae/*radiography ; Dexamethasone/administration & dosage ; Disability Evaluation ; Epidural Space/radiography ; Female ; Follow-Up Studies ; Humans ; Hyaluronoglucosaminidase/therapeutic use ; Injections, Epidural ; Intervertebral Disc Displacement/radiography/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain/drug therapy ; Pain/drug therapy ; Pain Measurement ; Questionnaires ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

Epiduroscopy is very useful in the treatment of not only low back pain caused by failed back surgery syndrome, epidural scar or herniated disc but also by chronic refractory low back pain which does not respond to interventional conservative treatment including fluoroscopically-directed epidural steroid injections and percutaneous adhesiolysis. Because cauterization using a laser fiber has become recently available, a wider opening is required to enter into the sacral canal in the case of epiduroscopic laser neural decompression (ELND). However, in a few patients, it is difficult to insert a device into the epidural space due to stenosis around the opening, and there is no alternative method. Herein, we report a case where a hiatus rasp specially designed for such patients was used to perform the operation.
Cicatrix ; Constriction, Pathologic ; Decompression ; Epidural Space ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Low Back Pain

OBJECTIVETo explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion.

METHODSFrom January 2002 to July 2011, the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65), the course of disease ranged from 1 month to 4 years (mean, 15 months). All patients manifested numbness and weakness of four limbs, unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function.

RESULTSTen patients were followed up, and the duration ranged from 15 to 32 months, with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20 +/- 1.55 preoperative to 13.60 +/- 1.90 postoperative (t = -11.8, P < 0.001), and excellent in 3 cases, good in 6 cases and moderate in 1 case.

CONCLUSIONAnterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Epidural Space ; diagnostic imaging ; surgery ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography