[Two cases of epidural neulolysis using ethyl alcohol and histopathologic changes in the spinal cord]

We report two cases of cancer pain treated with transcatheter thoracic epidural neurolysis using ethyl alcohol, and epidural histopathologic changes in the spinal cord observed in one of the patients. Case 1: A 59-year-old woman complained of intractable right thoracic back pain due to mediastinal osteo-sarcoma. After obtaining pain relief by epidural block using local anesthetics, we did transcatheter thoracic epidural alcohol block using 2-4 ml of 75-100% ethyl alcohol for three times. Her VAS score decreased from 8/10 to 2/10 and the good pain control was obtained until her death 24 days after the third block. After obtaining permission from her family, necropsy was performed. Spinal nerve roots and the spinal cord showed no abnormality. But the laminar structure of the dura had been destroyed at the outer one third of the dura. Case 2: A 49-year old woman suffered from right upper abdominal pain due to giant metastatic liver tumor. We performed twice transcatheter thoracic epidural neurolysis using 2-3 ml of 75% ethyl alcohol. Her VAS score decreased from 7/10 to 3/10 and the pain relief was maintained until her death 2.5 months after the neurolysis. Motor palalysis was not observed in both cases.