Epidural endoscopy can be used to treat intractable low back pain

Release date: 2006-08-14

Epidural laparoscopic surgery can be used to treat intractable low back pain. Recently, under the guidance of Robert Van Senventer, a professor of internationally renowned medicine and a professor of minimally invasive surgery in the Netherlands, Prof. Song Wenge and Professor Fu Zhiwei succeeded in being a stubborn Patients with low back pain completed an epidural laparoscopic operation under C-arm X-ray guidance. Postoperative patients with left lower extremity pain, numbness, chills and other symptoms disappeared, after rehabilitation activities, no symptoms of recurrence. This innovative approach has been a complete success.
The patient was a 33-year-old young woman with symptoms of pain in the left hip and buttocks 3 years ago. She was accompanied by numbness and coldness in the left lower limb. Her symptoms worsened after sedentary and tiredness. She was slightly relieved after bed rest. In order to relieve the pain, the patient had been treated in many hospitals in China, and the effect was not obvious. Later, he came to the department for treatment. The admission specialist was admitted to the hospital with “lumbar disc herniation”. The experts studied and discussed the patient's condition in detail, and agreed that the best efficacy can be obtained by epidural laparoscopic surgery. In view of the fact that the operation has not yet been carried out in China, Professor Robert Van Senventer, a Dutch expert who has done a good job in epidural laparoscopic surgery, is invited to the hospital for guidance.
During the operation, the doctor first used 1% lidocaine to make a ridge in the center of the patient's sacral hole, penetrated the skin through the dermatome, gradually infiltrated into the appendix ligament, and then changed to 18G Tuohy epidural needle. The split hole pierces the fistula and advances in the direction of the head. Use X-rays to see through the lateral position to confirm that the angle and position of the needle in the fistula are correct. Then, two milliliters of non-ionic contrast agent was injected through an epidural needle, and then fluoroscopy showed an epidural anatomical image including nerve roots, fat and adhesion band, and the left lateral filling defect of the lumbar vertebra 2/3 level indicated The patient has an epidural space adhesion. Under the guidance of the X-ray, the epidural needle was gently twisted in the direction of the head, and the guide wire was placed until the lesion was removed, and the Tuohy needle was withdrawn. Use a scalpel to enlarge the skin puncture hole to the appendix ligament, advance the dilator and guide sheath along the guide wire, and after entering the fistula, withdraw the guide wire and the dilator, and only retain the guiding sheath in the fistula. 10 ml of saline is used to rinse the side arm of the guiding sheath, and then the guiding tube with the fiber light guide endoscope is fed into the fistula through the guide, and the fiberoptic light guide endoscope is slowly sent into the epidural space along the guiding tube. Then to the lesion, the brush-like guidewire placed by the lateral tube removes the adhesion under direct vision and injects glucocorticoids and neurotrophic drugs into the target area.
After completing the operation for two hours, the left hip and hip pain and the numbness of the left lower extremity disappeared rapidly after the operation. There was no discomfort after the patient got out of bed. The patient only used a small amount of anesthesia during the operation. Unrestricted, normal activities can be performed, and the patient is discharged from hospital on the fourth postoperative day.
According to Professor Song Wenge, a famous pain expert in China, the epidural endoscope is a three-dimensional, dynamic and visual color imaging system that can directly look at the internal structure of the spinal canal. As a special diagnostic tool, it provides a basis for special clinical treatments, including surgery, and plays a unique role in the diagnosis and treatment of chronic low back pain. Experienced physicians can identify potential causes of pain, such as epidural adhesions, radiculous edema, epidural pressure, anatomical variation, nerve root cystic changes, and blood vessels with the aid of an epidural endoscope. Abnormal, etc. Epidural laposcopy can directly diagnose the nature of the lesion, and can directly inject into the lesion and perform adhesions. According to foreign prospective clinical trial data, epidural endoscopic adhesion lysis, simultaneous injection of hyaluronidase, glucocorticoids and ozone in the target area can effectively relieve the chronic obstruction caused by postoperative epidural adhesions. Low back and leg pain, the effect is exact and lasting. At the same time, for the CT and MRI examination can not determine the complex causes of low back pain, the use of epidural endoscopic diagnosis and treatment has its unique advantages.

Source: China Medical News

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