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      Técnicas de epiduroscopia en el tratamiento del dolor lumbar: una revisión sistemática de la literatura Translated title: Epiduroscopy techniques in the treatment of low back pain: a sistematic review

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          Abstract

          Objetivo: El dolor lumbar es una de las patologías más complejas en términos de costo-efectividad de los tratamientos. En este estudio evaluamos la utilidad de la epiduroscopia en el manejo de dolor lumbar, y su beneficio en comparación con las técnicas percutáneas tradicionales. Materiales y métodos: Se realizó una búsqueda de manera sistemática en las bases de datos PubMed, EMBASE, Cochrane y MedLine para artículos publicados entre enero de 1990 y diciembre de 2013. Se incluyeron estudios clínicos descriptivos y experimentos clínicos aleatorizados, excluyéndose estudios no clínicos, opiniones de expertos, etc. Resultados: Se obtuvieron 353 artículos en las 4 bases de datos, de los cuales sólo 78 pasaron el corte según criterios de exclusión e inclusión. Posteriormente se realizó un análisis crítico de los artículos según parámetros estandarizados. De los 78 artículos evaluados, se incluyeron 24 en la revisión final, 14 estudios evaluaron lisis de adherencias e inyección de esteroides, 3 estudios evaluaron la efectividad de la inyección epidural dirigida por epiduroscopia, mientras que los 7 restantes evaluaron otras intervenciones. Conclusiones: La epiduroscopia es una tecnología útil en el tratamiento del dolor lumbar con diferencias significativas en los resultados a largo plazo en ciertos pacientes. Esta tecnología es más útil en pacientes con antecedente quirúrgico con síntomas persistentes que en pacientes que no han sido intervenidos. De igual manera, cuando el dolor es de características radiculares, los resultados a largo plazo son más favorables que cuando se trata de dolor axial o inespecífico.

          Translated abstract

          Objectives: Low back pain is one of the most complex benign pathologies in terms of treatment cost and effectiveness. In the present study we evaluate the usefullness of epiduroscopy en treating low back pain and its benefit over traditional percutanoeus techniques Materials and methods: We carried out a sistematic search in 4 digital databases, PubMed, Embase, Cochrane and Medline. The search was limited to articles published between January 1990 and June 2014. Only clinical studies (both observational and experimental) were included. Results: We obtained 353 articles after a thorough search in all 4 databases of which only 78 met inclusión and exclusión criteria. These 78 articles were then critically reviewed by independent peers following standardized parameters. Twenty-four (24) articles were included in the review. Most of the articles (14) evaluated adhesiolysis and epidural injections, three studies evaluated directed epidural injections alone and the remaining articles were either alternate sistematic reviews or evaluated other interventions. Conclusions: Epidurosopy is a useful tecnique in the treatment of low back pain with statistically significant differences in the long-term results in select patients. Results are best in patients with persisting symptoms after spinal fusion and in patients whose symptoms are radicular and not axial or unspecific.

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          Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial.

          Chronic sciatica can be managed by caudal steroid epidural or by targeted steroid placement during spinal endoscopy. Spinal endoscopy is a new unproven procedure. We aimed to compare the two pain management techniques and to investigate whether the site of steroid placement within the epidural space was significant. We randomized 60 patients with a 6-18 months history of sciatica to either targeted epidural local anaesthetic and steroid placement with a spinal endoscope or caudal epidural local anaesthetic and steroid treatment. Pre-treatment and 6-week, 3-month, and 6-month SF-MPQ and HAD scores were recorded. No significant differences were found between the groups for any of the measures at any time. However, there were significant differences within both groups compared with pre-treatment values. For the caudal group, significant improvements were found for descriptive pain at 6 months (P=0.031), VAS at 6 weeks (P=0.036), 3 months (P=0.026), and 6 months (P=0.003), present pain intensity (PPI) at 3 months (P=0.013) and 6 months (P=0.01); anxiety at 6 weeks (P=0.008), 3 months (P=0.004), and 6 months (P=0.001) and depression at 6 months only (P=0.037). For the epiduroscopy group there were fewer significant changes. PPI was significantly reduced at 6 weeks (P=0.004) and at 6 months (P=0.02). Anxiety was reduced at 6 months only (P=0.03). The targeted placement of epidural steroid onto the affected nerve root causing sciatica does not significantly reduce pain intensity and anxiety and depression compared with untargeted caudal epidural steroid injection. When analysed individually, both techniques benefited patients.
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            Lysis of adhesions and epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis.

            Lumbar spinal stenosis causes various forms of back or leg pain, and is recognized with increasing frequency in elderly patients whose physical status is not always suitable for surgery. Epiduroscopy, a new, minimally invasive diagnostic and therapeutic technique, may be useful for pain relief in such patients. We investigated the epiduroscopic findings and immediate and long-term changes in back and leg pain after epiduroscopy in elderly patients with spinal stenosis. Patients with degenerative lumbar spinal stenosis (n=58, median age 71 yr) were divided into two groups based on presenting symptoms: a monosegmental group (n=34) and a multisegmental group (n=24). Each patient underwent epiduroscopy, and the findings were evaluated using visual analogue scales for low back and leg symptoms. Epiduroscopy included breaking down adhesions in the epidural space by injections of saline, and injection of steroids/local anaesthetic. Epiduroscopy showed that the amount of fatty tissue and the degree of vascularity were greater in the monosegmental group than in the multisegmental group. Relief of low back pain was observed up to 12 months after epiduroscopy in both groups. Relief of leg pain was evident up to 12 months after epiduroscopy in the monosegmental group, and up to 3 months after epiduroscopy in the multisegmental group. None of the patients showed deterioration of motor or sensory deficits during follow-up. One patient was excluded from analysis because of accidental dural puncture during the procedure. The findings of epiduroscopy corresponded to the symptoms. Epiduroscopy may reduce low back and leg pain in elderly patients with degenerative lumbar spinal stenosis, particularly those with radiculopathy.
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              The Comparison of the Result of Epiduroscopic Laser Neural Decompression between FBSS or Not

              Background Epiduroscopic laser neural decompression (ELND) has been performed as a treatment tool for chronic refractory low back pain and/or radicular pain. There are some studies about the usefulness of epiduroscopy for post lumbar surgery syndrome, however, few studies about the effectiveness of epiduroscopy for patients without back surgery. We compared the satisfaction of patients who underwent ELND for chronic low back pain and/or radicular pain after back surgery and for the same symptoms without surgery. Methods We compared the degree of satisfaction of patients after ELND between who had underwent the lumbar spine surgery and who had not retrospectively by chart reviewing. We divided 39 patients who had received ELND into two groups, one is the group of patients who got the lumbar surgery (group 1), and the other is the group of patients who did not (group 2). Their medical records including age, sex, previous treatment, duration of illness, degree of symptom relief were investigated. We compared each items between two groups. Results The number of patients in group 1 was 17, and group 2 was 22. In group 1, 16 patients (94.1%) showed more than 'Acceptable', and 19 patients (86.4%) showed more than 'Acceptable' in group 2. There is no significant differences statistically in percentage of patients who showed more than 'Acceptable' in the satisfaction after ELND between two groups. Conclusions ELND provided satisfaction (more than 85%) for patients with chronic low back pain and/or leg pain regardless of previous back surgery history.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                August 2016
                : 23
                : 4
                : 191-201
                Affiliations
                [01] orgnameHospital Universitario San Ignacio orgdiv1Departamento de Neurociencias
                [02] Bogotá orgnamePontificia Universidad Javeriana orgdiv1Facultad de Medicina Colombia
                Article
                S1134-80462016000400006
                10.20986/resed.2016.3437/2016
                83de2499-24f4-4615-a0c4-7ac9df5fa150

                http://creativecommons.org/licenses/by/4.0/

                History
                : 20 July 2015
                : 21 September 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 11
                Product

                SciELO Spain


                Endoscopia epidural,inyeccion epidural,dolor lumbar,lisis de adherencias,Epidural endoscopy,epidural injections,low back pain,adhesiolysis

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