• Annals of Clinical Neurophysiology
• /
• v.19 no.1
• /
• pp.71-73
• /
• 2017

The spinal segmental myoclonus by viral radiculitis has been rarely reported and the pathophysiology remains to be elucidated. However, the hyperactivity of contiguous anterior horn neurons induced by viral irritation has been suggested to be a possible patho-mechanism. In general, spinal segmental myoclonus is not well-controlled by medication and the patient suffers from continuous involuntary movement. We recently experienced a case of spinal segmental myoclonus induced by herpes zoster radiculitis, and which was successfully relieved by epidural injections.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.3
• /
• pp.268-271
• /
• 2010

The ADCON-L $gel^{(R)}$ (Gliatech, Cleveland, OH, USA), a carbohydrate polymer gel. has been shown in a controlled clinical study to inhibit postsurgical adhesions and improve a patient's clinical outcome. Immediate complication of this gel has been reported in the recent literature including back pain, radiculitis and durotomy. However, delayed detection of disturbance of muscle healing and attachment in late postoperative state has been rarely reported. This report documents an unexpected delayed detected complication of the anti-adhesion barrier gel. which was used after lumbar discectomy one year ago, with review of literature.

• The Korean Journal of Pain
• /
• v.28 no.1
• /
• pp.11-21
• /
• 2015

Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.

• The Korean Journal of Pain
• /
• v.27 no.4
• /
• pp.353-359
• /
• 2014

Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.