Purpose
The purpose of this study was to determine the early failure rate of percutaneous epidural neuroplasty (PEN) that led to subsequent decompressive lumbar surgery. We also assessed the limits of spinal pain management by using the current PEN technique.
Materials and Methods
We classified 1763 cases according to their diagnoses and radiological findings. Patients who underwent subsequent open surgery when PEN failed to improve or aggravated their symptoms were included.
Results
All 37 patients underwent open decompressive surgery within 3 months after PEN. There were 18 in the intracanalicular focal herniation category, 11 in intracanalicular broad based herniation category, and 8 in foraminal category; the early failure rates were 1.7%, 1.9%, and 5.6%, respectively. There was no significant statistical difference between the intracanalicular categories with regard to failure rate, but the foraminal category had a higher rate of failure than that of intracanalicular categories (p<0.05). Moreover, there were 11 cases in intracanalicular categories that experienced deterioration or new symptoms due to posterior longitudinal ligament rupture or fragment migration. Among these, there were 9 cases (82%) with preexisting intracanalicular migrating fragments.
Conclusion
PEN with targeted drug delivery may be an effective treatment for low back pain and/or radiculopathy. However, its early failure rate is at least 2.1%, and the presence of intracanalicular migrating fragments or symptomatic foraminal lesions are predictors of poor outcome. Patients must be carefully selected on the basis of thorough radiologic reviews to improve the rate of satisfactory PEN outcomes.

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.