Purpose To say the medical and social issues as to the percutaneous epidural adhesiolysis.
Materials and Methods Chronological alteration of the performance was reviewed. Its superiority to the other conventional interventional therapy was reviewed. It was investigated whether the effect of its instruments and drugs coincided with its purpose from the medical and social points of view.
Results Its fundamental purpose is adhesiolysis. The evidence, however, that adhesion is related with spinal symptoms was unclear. It seems absurd to recognize the effects of instruments and drugs before verification of symptom contribution of adhesion. According to the literatures, there was no additional benefit in using hyaluronidase, rather it brought about complications such as anaphylaxis. Hypertonic saline had serious side effects even though it improved the results. The effect of steroid did not outrun that of placebo. Local anesthetics reduced pain, but it had nothing to do with adhesion. The overstatement of its effect gave rise to confusion in therapeutic algorithm in spinal diseases. Also the suffix ‘-plasty’ which has the meaning of forming surgically is inappropriate for the procedure of some epidural injection.
Conclusion It is necessary to clarify the purpose and action mechanism of percutaneous epidural neuroplasty and establish appropriate indications. Then the misnomer should be corrected on the bases of its possible applications.
Epiduroscopy which is the latest development in clinical application of the endoscopy in human body is gaining more popularity in recent days. As the interest in the percutaneous neuroplasty in the non-surgical treatment of spinal pain is increasing among the physicians dealing chronic pain from spinal origin, the interest about epiduroscopic pain treatment is increasing also. The epiduroscopic pain treatment has an inherent advantage of observing the offending pathology directly. In line with this, small, but continuous reports regarding the effectiveness of the epiduroscopic pain treatment has been reported in the literature against for chronic pain from post-spinal surgery syndrome, lumbosacral radiculopathy from herniated lumbar disc and spinal stenosis, and chronic low back pain. However, epiduroscopic pain treatment has disadvantages of furnishing the complex equipments, more detailed procedures, and demanding more time in the procedure. The risks of ophthalmological complications associated with injudicious use of the irrigation saline during the procedure has been stressed several times. Other complications related to the techiniques of epidural anesthesia have already been reported. More thoughtful application of the epiduroscopy for the chronic pain of benign spinal pathology is warranted.
Summary of Background Data Recently, minimal invasive spine surgery has been used and spine surgeons are prone to the radiation exposures.
Objectives: To determine the radiologic hazard to the spine surgeon.
Methods We searched the PUBMED, MEDLINE with Mesh term from MIS, radiation exposure.
Results We reviewed the radiation exposure in different disease and surgery. There exist significant dose of radiation exposures in MIS Discectomy, MIS or open pedicle screw fixation, and kyphoplasty.
Conclusion Surgeons should aware of the radiation exposure of the spine surgery and should do efforts on minimize it.
Purpose The main purpose of this study was the investigation of the effect of Dexamethasone (DEXA) treatment on TNF-α stimulated intervertebral disc cells through the action mechanism of NF-κB in the cytoplasm and nucleus.
Materials and Methods We separated cultured human intervertebral disc cells passed three times into four groups. A:
control group, B: TNF-α treatment group, C: DEXA treatment group, D: TNF-α and DEXA treatment simultaneously.
After extraction of cytoplasmic and nuclear protein from the 4 groups at time points including 10 minutes, 1 hour, and 2 hours, we measured the protein expression levels of p50, p65, p52, and p100 by western blot analysis. Also, we observed the expression of p50, p52, p65 in each group at the 1 hour time point by immunofluorescence analysis.
Results Western blot analysis demonstrated that cytoplasmic levels of p50 and p65 at1 hour in groups B and D were decreased, groups C showed no significant change as compared to the control group. Nuclear levels of p50 at 1 hour in groups B (10.99 fold) and D (7.24 fold) were increased, and group D had decreased expression compared to group B. Nuclear levels of p50 expression at 2 hours in groups B (12.33 fold) was increased compared to the levels measured at 1 hour. Levels of nuclear p50 in group D at 2 hour time points showed no significant change as compared to the group D at 1 hour time points. In the nucleus, the level of p65 at 1 hour had the same pattern as the p50 expression, however, group B (4.13 fold) and D (4.13 fold) expression levels at 2 hours were decreased compared to the group B (7.49 fold) and D (6.79 fold) at 1 hour. In the cytoplasm, the expression of p100 in groups B and D were decreased after 1hour, and other groups had the same trend as that observed for the control group. Nuclear p100 expression levels were observed in, groups B, C, and D after 2 hours. The cytoplasmic levels of p52 at 10min, 1 hour, and 2 hours were same. The nuclear levels of p52 in group D at 1 hour had no expression and decreased at 2 hours (0.08 fold). The results of the immunofluorescence analysis and the western blot analysis at the 1 hour time point is quite consistent.
Conclusion Transcriptional mediation of NF-κB was mainly focused on the classical pathway but several protein levels were influenced by the alternative pathway following stimulation with TNF-α in disc cells. The effect of DEXA on NF-κB transcription signaling was observed through the delayed expression of involved proteins and inhibited the translocation of p50, p52, p65 to prevent the expression of corresponding genes.
Purpose A surgical treatment has been preferred in patients with unstable lumbar spine fracture-dislocation with incomplete paraplegia as it does not cause further nerve injury by regenerating and maintaining the shape of the spinal canal via the accurate reduction of fracture, and prevents additional complications by preventing neurovascular injury that secondarily occurs.1) However, the surgical treatment may be delayed or even impossible in patients with hemodynamic unstable state caused by an emergent concurrent injury. Accordingly, Stage operation was conducted on patients with unstable lumbar spine fracture-dislocation with incomplete paraplegia who had a difficulty in undergo immediate reduction and decompression due to hemodynamic unstable state caused by other concurrent injuries.
Methods Postural reduction and minimal invasive percutaneous pedicle screw fixation L1-4 were conducted as a first stage operation, and L2-3 partial laminectomy, discectomy, and posterior fusion were then conducted as a second stage operation by applying the concept of stage operation in the department of spinal surgery.
Results The first stage operation had a blood loss of 150cc and an operation time of 58 min. Compared to motor grade 3 shown in preoperative status, motor grade 4 was shown in L3 level or lower in a postoperative physical examination. The second stage operation was conducted two weeks later. It had an operation time of 90 min and a blood loss of 500cc. no neurologic change was further found.
Conclusion Stage operation was conducted on patients with hemodynamic unstable state. Postural reduction and minimal invasive percutaneous pedicle screw fixation were conducted as a first stage operation to achieve the immediate reduction and stability of fracture and dislocation and the improvement of neurologic deficits.
Subsequently, decompression or fusion was conducted as a second stage operation under stable systemic status for through and accurate operation.
Neurological complications related to spinal surgery are not common, but can result in catastrophic clinical failures.
The ultimate goal during the operation should be to try to reduce and prevent a severe neurologic complication by careful preoperative planning and attention to trivial details related to the patients and their pathologies. It is very critical and important to understand the potential neurological complications that can occur during the operation and to manage them if they should happen. In our review article, general principles associated with various neurologic complications are reviewed and discussed.
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