Korean J Pain.  2018 Oct;31(4):296-304. 10.3344/kjp.2018.31.4.296.

Complication of epiduroscopy: a brief review and case report

• Marchesini M
• Flaviano E
• Bellini V
• Baciarello M
• Bignami EG

• KMID: 2421521
• DOI: http://doi.org/10.3344/kjp.2018.31.4.296

Abstract

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.

Keyword

Cicatrix; Epidural space; Failed back surgery syndrome; Low back pain; Neurogenic urinary bladder; Paresthesia; Pharmaceutical preparations; Pneumocephalus; Post-dural puncture headache; Retinal hemorrhage; Tissue adhesions

MeSH Terms

Brain Diseases
Cicatrix
Epidural Space
Failed Back Surgery Syndrome
Hearing Loss
Humans
Inflammation
Leg
Low Back Pain
Paresthesia
Pharmaceutical Preparations
Pneumocephalus
Post-Dural Puncture Headache
Punctures
Retinal Hemorrhage
Rhabdomyolysis
Seizures
Tears
Tissue Adhesions
Urinary Bladder, Neurogenic
Vision Disorders
Pharmaceutical Preparations

Figure

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  Fig. 1 MRI lumbar scan before periduroscopy.

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  Fig. 2 Flexible Epidural Videoguide.

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  Fig. 3 Introducer Kit: 1: Rigid dilatator 8 F; 2: guide wire 0,38′′× 50; 3: Touhy needle 17G; 4: rigid dilatator 12 F; 5: introducer 10F.

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  Fig. 4 CT brain scan, white arrows show airbubbles.

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  Fig. 5 CT scan of L4-L5 level, white arrow shows airbubbles.

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  Fig. 6 Prisma chart of review.

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  Fig. 7 Fitted close circuit for fluid injection.

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