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      Sacral root injury during trans-sacral epiduroscopic laser decompression : A case report

      case-report

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          Abstract

          Rationale:

          Trans-sacral epiduroscopic laser decompression (SELD) is reported to have strong positive short-term effects in controlling lower back pain (LBP) or radicular leg pain following herniated lumbar disc (HLD). However, little is known about the possible complications following SELD.

          Patient concerns:

          A 36-year-old man received SELD with YAG laser for controlling LBP and radicular pain due to HLD on L5-S1. However, after SELD, voiding and defecation difficulties and sensory deficits on the S3-5 dermatome were presented.

          Diagnoses:

          An areflexic neurogenic bladder was demonstrated by a urodynamic study four days after onset of sacral nerve root injury symptoms. In the electromyogram study, latency of electrically induced bulbocavernosus reflex (BCR) was delayed on both sides at four days after symptom onset. Based on the patient's symptoms and the results of the clinical evaluation, we diagnosed the patient as having an injury in the sacral nerve roots.

          Interventions:

          The patient was observed without any specific medication.

          Outcomes:

          Three months after symptom onset, the patient's voiding and defecation difficulties were nearly completely recovered.

          Lessons:

          In this study, we described a patient who showed neurogenic bladder and bowel and sensory deficits in the S3 to S5 dermatome due to sacral nerve root injury after SELD. During SELD, clinicians should be mindful of the possibility of injury to sacral nerve roots.

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          Most cited references9

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          Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty: A 10 Year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery

          Background Conventional diagnosis between axial and foraminal stenosis is suboptimal and long-term outcomes limited to posterior decompression. Aware state Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty (TELDF) offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis failing to respond to conventional rehabilitation, pain management or surgery. This prospective survivability study examines the outcomes 10 years after TELDF in patients with foraminal stenosis arising from degeneration or failed back surgery. Methods For 10 years prospective data were collected on 114 consecutive patients with multilevel spondylosis and neuro-claudicant back pain, referred pain and weakness with or without failed back surgery whose symptoms had failed to respond to conventional rehabilitation and pain management and who underwent TELDF. The level responsible for the predominant presenting symptoms of foraminal stenosis, determined on clinical grounds, MRI and or CT scans, was confirmed by transforaminal probing and discography. Patients underwent TELDF at the spinal segment at which the predominant presenting symptoms were reproduced. Those that required treatment at an additional segment were excluded. Outcomes were assessed by postal questionnaire with failures being examined by the independent authors using the Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Prolo Activity Score. Results Cohort integrity was 69%. 79 patients were available for evaluation after removal of the deceased (12), untraceable (17) and decliners (6) from the cohort. VAP scores improved from a pre-operative mean of 7.3 to 2.4 at year 10. The ODI improved from a mean of 58.5 at baseline to 17.5 at year 10. 72% of reviewed patients fulfilled the definition of an “Excellent” or “Good Clinical Impact” at review using the Spinal Foundation Outcome Score. Based on the Prolo scale, 61 patients (77%) were able to return and continue in full or part-time work or retirement activity post-TELDF. Complications of TELDF were limited to transient nerve irritation, which affected 19% of the cohort for 2 – 4 weeks. TELDF was equally beneficial in those with failed back surgery. Conclusions TELDF is a beneficial intervention for the long-term treatment of severely disabled patients with neuro-claudicant symptoms arising from spinal or foraminal stenosis with a dural diameter of more than 3mm, who have failed to respond to conventional rehabilitation or chronic pain management. It results in considerable improvements in symptoms and function sustained 10 years later despite co-morbidity, ageing or the presence of failed back surgery. Clinical Relevance The long term outcome of TELDF in severely disabled patients with neuro-claudicant symptoms arising from foraminal stenosis which had failed to respond to conventional rehabilitation, surgery or chronic pain management suggests that foraminal pathology is a major cause of lumbar axial and referred pain and that TELDF should be offered as primary treatment for these conditions even in the elderly and infirm. The application of TELDF at multiple levels may further widen the benefits of this technique.
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            Trans-Sacral Epiduroscopic Laser Decompression for Symptomatic Lumbar Disc Herniation: A Preliminary Case Series.

            The purpose of this study was to investigate the effect of trans-sacral epiduroscopic laser decompression (SELD) in patients with a herniated lumbar disc.
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              Treatment of lumbar intervertebral disc herniation using C-arm fluoroscopy guided target percutaneous laser disc decompression.

              To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                October 2017
                20 October 2017
                : 96
                : 42
                : e8326
                Affiliations
                Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea.
                Author notes
                []Correspondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu 705-717, Republic of Korea (e-mail: wheel633@ 123456hanmail.net ).
                Article
                MD-D-17-03699 08326
                10.1097/MD.0000000000008326
                5662411
                29049245
                1e89878c-6882-4d71-b9aa-e282d430452a
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 14 June 2017
                : 1 September 2017
                : 6 September 2017
                Categories
                3300
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                bulbocavernosus reflex,herniated lumbar disc,sacral nerve root injury,trans-sacral epiduroscopic laser decompression,urodynamic study

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