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Epidural steroids for treating "failed back surgery syndrome": is fluoroscopy really necessary?
1Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba, Israel.
Anesthesia and Analgesia
|February 11, 1999
Summary
Loss of resistance technique reliably identifies the epidural space for failed back surgery syndrome treatment. However, surface anatomy is inaccurate, and steroid spread to pathology occurs in only 26% of cases.
Area of Science:
- Pain Management
- Neurosurgery
- Radiology
Background:
- Epidural steroid injections are common for failed back surgery syndrome (FBSS).
- Accurate steroid placement is crucial for patient response.
- Fluoroscopic guidance is advocated but costly; cost-benefit needs evaluation.
Purpose of the Study:
- To evaluate the reliability of the air loss of resistance technique for epidural space identification in FBSS.
- To assess the accuracy of predicting intervertebral levels for epidural injections.
- To determine the spread of contrast medium within the epidural space.
Main Methods:
- Prospective, controlled, single-blinded study of 50 FBSS patients.
- Epidural space identified using air loss of resistance technique.
- Contrast medium administered via epidural catheter; lumbar spine radiographs obtained.
Main Results:
- The air loss of resistance technique successfully identified the epidural space in 44 out of 48 cases.
- Clinician prediction of intervertebral level was inaccurate in 25 patients.
- Contrast medium did not reach the pathology level in 35 patients.
Conclusions:
- Loss of resistance is a reliable indicator of epidural penetration in FBSS.
- Surface anatomy is unreliable for accurate epidural injection site prediction.
- Effective spread of steroid to pathology occurs in only 26% of cases.