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Lumbar epidural

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https://www.readbyqxmd.com/read/28803898/electrospun-fibrous-membranes-featuring-sustained-release-of-ibuprofen-reduce-adhesion-and-improve-neurological-function-following-lumbar-laminectomy
#1
Shen Liu, Guoqing Pan, Guangwang Liu, José das Neves, Sa Song, Shuai Chen, Bangjun Cheng, Zhiyong Sun, Bruno Sarmento, Wenguo Cui, Cunyi Fan
Electrospun fibrous membranes provide suitable physical anti-adhesion barriers for reducing tissue anti-adhesion following surgery. However, often during the biodegradation process, these barriers trigger inflammation and cause a foreign body reaction with subsequent decrease in anti-adhesion efficacy. Here, a facile strategy comprising the incorporation of ibuprofen (IBU) into implantable membranes and its sustained release was proposed in order to improve anti-adhesion effects and neurological outcomes, namely to prevent failed back surgery syndrome (FBSS)...
August 10, 2017: Journal of Controlled Release: Official Journal of the Controlled Release Society
https://www.readbyqxmd.com/read/28796547/do-superior-or-inferior-interlaminar-approach-or-bevel-orientation-predispose-to-nonepidural-needle-penetration
#2
Nicholas A Koontz, Richard H Wiggins, Gregory J Stoddard, Lubdha M Shah
OBJECTIVE: There is a paucity of evidence-based literature regarding the advantages and disadvantages of the interlaminar approach and needle bevel orientation for performing a lumbar interlaminar epidural steroid injection (ESI). The purpose of this study was to determine if superior versus inferior lamina approach, needle bevel tip orientation, or both may predispose to inadvertent nonepidural penetration during lumbar interlaminar ESI. SUBJECTS AND METHODS: A prospective study was performed of patients with low back pain with or without radicular pain or neurogenic claudication referred for lumbar interlaminar ESI...
August 10, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28796132/optimal-point-of-insertion-and-needle-angle-in-neuraxial-blockade-using-a-midline-approach-a-study-in-computed-tomography-scans-of-adult-patients
#3
Mark Vogt, Dennis J van Gerwen, Wouter Lubbers, John J van den Dobbelsteen, Martin Hagenaars
BACKGROUND AND OBJECTIVES: Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative to the skin at which the needle should approach the epidural or subarachnoid space. METHODS: A computer algorithm systematically analyzed computed tomography scans of vertebral columns of a cohort of 52 patients...
August 8, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28795472/does-ultrasound-guidance-add-accuracy-to-continuous-caudal-epidural-catheter-placements-in-neonates-and-infants
#4
Vrushali C Ponde, Vinit V Bedekar, Ankit P Desai, Kiran A Puranik
BACKGROUND: Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement. METHODS: We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block...
August 10, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28774283/effectiveness-of-spinal-cord-stimulation-for-painful-camptocormia-with-pisa-syndrome-in-parkinson-s-disease-a-case-report
#5
Hisanao Akiyama, Saki Nukui, Masashi Akamatu, Yasuhiro Hasegawa, Osamu Nishikido, Soichiro Inoue
BACKGROUND: Spinal cord stimulation (SCS) has recently been reported to be effective for truncal postural abnormalities such as camptocormia and Pisa syndrome in Parkinson's disease. In this case report, we describe a case of a woman with Parkinson's disease in whom SCS was effective for painful camptocormia with Pisa syndrome. CASE PRESENTATION: A 65-year-old woman was admitted to our hospital because of painful camptocormia. She had noticed resting tremor in the left upper limb and aprosody at 48 years of age...
August 3, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28759948/the-role-of-epidural-contrast-distribution-in-predicting-the-effectiveness-of-steroid-and-local-anesthetic-injection-in-patients-with-lumbar-spinal-stenosis
#6
Jong Won Kwon, Sang Jun Kim
STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection...
July 14, 2017: Journal of Back and Musculoskeletal Rehabilitation
https://www.readbyqxmd.com/read/28757767/anesthesia-for-a-patient-with-unexpected-giant-tracheobronchomegaly
#7
Chien-Ching Lee, Bor-Shyh Lin, Jen-Yin Chen, Chia-Chun Chuang
Tracheobronchomegaly (also called Mounier-Kuhn syndrome) is a rare disease characterized by flaccid and markedly dilated trachea and main bronchi on inspiration with narrowing or collapse on expiration or cough. It is associated with recurrent lower respiratory tract infection. A 75-year-old man with unexpected giant tracheomegaly had a significant peritubal air leak which impeded an operation. Lumbar epidural anesthesia was performed for a subsequent operation without any sequela. Careful evaluation with chest radiography is basic to exclude a large airway...
January 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28756300/obesity-and-spinal-epidural-lipomatosis-in-cauda-equina-syndrome
#8
Duncan Cushnie, Jennifer C Urquhart, Kevin R Gurr, Fawaz Siddiqi, Christopher S Bailey
BACKGROUND CONTEXT: Although lumbar disc herniations are common, only a small portion of these herniations lead to cauda equina syndrome (CES) which is an uncommon but debilitating disorder. Why some patients with herniation develop CES, when most do not, remains unknown. Pre-existing subclinical epidural lipomatosis may limit canal space such that an otherwise benign herniation causes CES. PURPOSE: This study determines whether patients with an acute disc herniation and CES have a greater body mass index (BMI) and greater quantity of epidural fat compared to control subjects with non-CES symptomatic lumbar herniated discs...
July 26, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28745066/a-comparison-of-the-efficacy-and-tolerability-of-the-treatments-for-sciatica-a-network-meta-analysis
#9
Jian-Rong Guo, Xiao-Ju Jin, Hua-Chun Shen, Huan Wang, Xun Zhou, Xiao-Qian Liu, Na-Na Zhu
BACKGROUND: There remains a lack of a systematic summary of the efficacy and safety of various medicines for sciatica, and discrepancies among these exist. OBJECTIVE: The aim of this study is to comprehensively assess the efficacy of and tolerance to several medical options for the treatment of sciatica. METHODS: We performed a network meta-analysis and illustrated the results by the mean difference or odds ratio. The surface under the cumulative ranking curve (SUCRA) was used for indicating the preferable treatments...
July 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28731977/interventions-for-neuropathic-pain-an-overview-of-systematic-reviews
#10
REVIEW
Svjetlana Dosenovic, Antonia Jelicic Kadic, Maja Miljanovic, Marina Biocic, Krste Boric, Marija Cavar, Nikolina Markovina, Katarina Vucic, Livia Puljak
Numerous interventions for neuropathic pain (NeuP) are available, but its treatment remains unsatisfactory. We systematically summarized evidence from systematic reviews (SRs) of randomized controlled trials on interventions for NeuP. Five electronic databases were searched up to March 2015. Study quality was analyzed using A Measurement Tool to Assess Systematic Reviews. The most common interventions in 97 included SRs were pharmacologic (59%) and surgical (15%). The majority of analyzed SRs were of medium quality...
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28727718/quantity-of-disc-removal-and-radiological-outcomes-of-percutaneous-endoscopic-lumbar-discectomy
#11
Ji Han Heo, Chi Heon Kim, Chun Kee Chung, Yunhee Choi, Young-Geun Seo, Dong Hoi Kim, Sung Bae Park, Jung Hyeon Moon, Won Heo, Jong-Myung Jung
BACKGROUND: Herniated intervertebral disc disease (HIVD) is a common cause of lower back and leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is indicated when non-surgical treatments such as medication and interventions are intractable. Ruptured discs and loose fragments inside discs are removed during PELD. Nerve root decompression is usually assessed by visualizing the free movement of the traversing nerve root or epidural fat, the free passage of a probe into the epidural space, the depression of the annulus, and the removal of the expected ruptured discs and loose fragments based on preoperative magnetic resonance images (MRI)...
July 2017: Pain Physician
https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#12
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28720991/transforaminal-epidural-etanercept-for-the-treatment-of-prolapsed-lumbar-intervertebral-disc-induced-sciatica
#13
Ashish Dagar, Ramesh Kumar, Abhishek Kashyap, Vinay Prabhat, Hitesh Lal, Lalit Kumar
STUDY DESIGN: Hospital based prospective study. OBJECTIVE: To study clinical response of transforaminal epidural Etanercept for lumbar prolapsed intervertebral disc induced sciatica. METHOD: Patients presenting to O.P.D and Emergency services of our hospital were screened for inclusion and exclusion criteria & suitable candidates were enrolled in study. Patients received 2 transforaminal epidural injections of Etanercept 2 mg, 2 weeks apart, and were assessed for efficacy at 2 week, 1 month and 3 months after the second injection...
April 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28720990/selective-nerve-root-blocks-vs-caudal-epidural-injection-for-single-level-prolapsed-lumbar-intervertebral-disc-a-prospective-randomized-study
#14
Sudhir Singh, Sanjiv Kumar, Gaurav Chahal, Reetu Verma
BACKGROUND: Chronic lumbar radiculopathy has a lifetime prevalence of 5.3% in men and 3.7% in women. It usually resolves spontaneously, but up to 30% cases will have pronounced symptoms even after one year. AIMS: A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and selective nerve root block in management of pain and disability in cases of lumbar disc herniation. METHODS: Eighty patients with confirmed single-level lumbar disc herniation were equally divided in two groups: (a) caudal epidural and (b) selective nerve root block group, by a computer-generated random allocation method...
April 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28716031/a-rare-case-of-intradural-and-extramedullary-epidermoid-cyst-after-repetitive-epidural-anesthesia-case-report-and-review-of-the-literature
#15
Haruki Funao, Norihiro Isogai, Kenshi Daimon, Yuichiro Mima, Hitoshi Sugiura, Takahiro Koyanagi, Masaya Nakamura, Morio Matsumoto, Ken Ishii
BACKGROUND: Spinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia...
July 17, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28708040/anterior-lumbar-discectomy-and-fusion-for-acute-cauda-equina-syndrome-caused-by-recurrent-disc-prolapse-report-of-3-cases
#16
Kimberly-Anne Tan, Mathew D Sewell, Yma Markmann, Andrew J Clarke, Oliver M Stokes, Daniel Chan
There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage. The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy...
July 14, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28704909/tophaceous-gout-in-the-lumbar-spinal-canal-mimicking-epidural-spinal-tumor
#17
Taeshin Kim, Bum-Joon Kim, Se-Hoon Kim, Seung-Hwan Lee
Gout is an inflammatory arthritis characterized by deposition of monosodium urate crystals in joints. Though gout frequently involves the big toe or other extremities, it rarely occurs in the spinal canal. A 35-year-old man presented with left L5 radiculopathy. He had leg pain for 8 months and received several epidural steroid injections. Magnetic resonance imaging revealed a 1.7×1.1-cm ovoid contrast-enhancing mass, causing pressure erosion of the left L5 pedicle. Microscopic laminotomy was performed at the left L5 lamina...
June 2017: Korean Journal of Spine
https://www.readbyqxmd.com/read/28701540/a-novel-paraplegia-model-in-awake-behaving-macaques
#18
Max Ostrinsky Krucoff, Katie Zhuang, David B Macleod, Allen Yin, Yoon Woo Byun, Roberto Jose Manson, Dennis A Turner, Laura Oliveira, Mikhail A Lebedev
Lower limb paralysis from spinal cord injury (SCI) or neurological disease carries a poor prognosis for recovery and remains a large societal burden. Neurophysiological and neuroprosthetic research have the potential to improve quality of life for these patients; however, the lack of an ethical and sustainable non-human primate model for paraplegia hinders their advancement. Therefore, our multi-disciplinary team developed a way to induce temporary paralysis in awake behaving macaques by creating a fully implantable lumbar epidural catheter-subcutaneous port system that enables easy and reliable targeted drug delivery for sensorimotor blockade...
July 12, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28697031/epidural-injections-contraindicated-for-lumbar-radiculopathy-in-may-thurner-syndrome-a-case-report
#19
Michael Sniderman
A 59-year-old patient presented to the chronic pain clinic with a 6-week history of worsening lumbar back pain, bilateral thigh pain, and unilateral radiculopathy. Magnetic resonance imaging revealed mild discogenic and facetogenic disease, but significant epidural venous plexus engorgement compressing the thecal sac. The patient reported previous treatment by a vascular surgeon for May-Thurner Syndrome, a type of inferior vena caval obstruction, yet had not experienced these specific complaints. A discussion with the radiologist confirmed worsening of the patient's May-Thurner Syndrome was the likely cause of the patient's symptoms...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28696946/optimal-treatment-for-lumbar-spinal-stenosis-an-update
#20
Janus Patel, Ian Osburn, Anne Wanaselja, Ryan Nobles
PURPOSE OF REVIEW: Our review of current literature within the past 12-24 months for the treatment of lumbar spinals stenosis (LSS) serves to update providers on recent advances and comparisons regarding therapy spanning lifestyle modification, pharmacologic therapy, minimally invasive interventions, and surgical interventions. RECENT FINDINGS: Current literature supporting the inclusion of physical therapy and gabapentin/pregabalin within an initial treatment regimen have been positive...
July 10, 2017: Current Opinion in Anaesthesiology
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