Background: Pneumocephalus can originate from accidental dural puncture while performing epidural block using the loss-of-resistance (LOR) technique with an air-filled syringe.
Case: We present two cases of pneumocephalus after lumbar epidural block under fluoroscopy for pain control in elderly patients.
Conclusions: Lumbar epidural block should be performed under fluoroscopic guidance in elderly patients with severe lesions. The physician should be aware of the increased possibility of a dural puncture occurring due to anatomical changes in older patients. The use of saline is recommended for the LOR technique. A contrast injection should be used together with the LOR technique to locate the epidural space. If a dural puncture occur, the patient should be carefully monitored to determine whether pneumocephalus has developed.
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http://dx.doi.org/10.17085/apm.19087 | DOI Listing |
J Neurosurg Pediatr
January 2025
2Norton Children's Hospital and Norton Children's Neuroscience Institute, Norton Healthcare, Louisville; and.
Objective: CSF leaks are a significant source of patient morbidity following intradural spine surgeries. Watertight dural closure is crucial during these procedures to minimize the risk of a CSF leak. This study reports postoperative outcomes and changes in patient management after switching to penetrating titanium clips for dural closure in a large cohort of pediatric patients receiving a tethered cord release (TCR) or a selective dorsal rhizotomy (SDR).
View Article and Find Full Text PDFNeurosurg Rev
January 2025
Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
This study aims to thoroughly investigate the clinical presentation, duration of symptoms, radiological aspects of posterior epidural migration of disc fragments (PEMDF), and assess various treatment options and their impacts on patient functionality. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a comprehensive search in PubMed, Web of Science, and Scopus from inception to March 2024.
View Article and Find Full Text PDFRev Med Liege
January 2025
Service de Médecine Physique et Traumatologie du Sport, CHU Liège, Belgique.
The prevalence of chronic low back pain is high and rising. Chronic low back pain is «non-specific» in approximately 90 % of cases. In addition to age, risk factors include smoking, obesity, physical and psychological stress, as well as demographic factors.
View Article and Find Full Text PDFPLoS One
January 2025
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America.
Epidural steroid injections (ESIs) are often used to treat low back pain (LBP) due to lumbosacral radiculopathy as well as LBP without a clear component of radiculopathy, in some cases. While it is increasingly recognized that psychosocial factors are associated with pain outcomes, few studies have assessed the contribution of these factors to common pain interventions like ESIs. This study aimed to summarize the scope and nature of how psychosocial factors are accounted for in research on ESIs for the treatment of LBP with or without lumbosacral radiculopathy and to identify gaps and recommendations for future research.
View Article and Find Full Text PDFAnesth Pain Med (Seoul)
November 2024
Department of Anesthesia and Pain Medicine, Alfayoum University, Alfayoum, Egypt.
Background: Failed back surgery syndrome is a common problem faced by chronic pain management specialists. Steroid-only epidural injections have modest efficacy because of excessive scarring. Epidural hyaluronidase (HA), functions as a depolymerizing agent, successfully breaking down adhesions and collagen bundles, whereas dexmedetomidine (DEX) helps to reduce inflammation.
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