Title: Advantages Roles of Epiduroscopic Techniques in Diagnostic plus management of Lumbar Canal Stenosis
Authors: Ahmed Alkhuzai F.I.C.M.S, Shahla Mohammed Saeed Rasul F.I.C.M.S
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.88
Abstract
Background: Lumbar Canal Stenosis as commonest disorder affected by degenerative spine diseases which is required surgical intervention. These disorders depend on clinical and MRI picture alone in diagnostic data assessment. We advise to use confirmatory diagnostic interventional Epiduroscopic technique to improve diagnosis, also more as supportive technique during managements of lumbar canal stenosis.
Aim of study: We evaluated the effectiveness of percutaneous Interventional Epiduroscopic Techniques in diagnosis, plus advantages in management of Lumbar Canal Stenosis.
Patients & Methods: A prospective study of 40 patients with Lumbar Canal Stenosis, were diagnosed in Sulaimaniyah city private clinic and private hospital from July 2012 till August 2014, according to the clinical presentation, plus MRI Magnetic Resonance Imaging techniques, also according to inclusion exclusion criteria in diagnosis of stenosis clinically, radiologically. All these patients were preparing for treatment by lumbar spine surgery exploration with decompression laminectomy, post using the Percutaneous Epiduroscopic Techniques through sacral canal under fluoroscopic guide, there were 14 patients excluded from surgical decompression laminectomy, after using Epiduroscope. That observe the canal closures will open by Epiduroscopic technique, when only primary tethering the roots within the cord were seen, post exclusion the secondary tethered cord syndrome. Also, the patients become free from sign of stenosis & improvement of claudication clinically immediately post interventional procedure by Percutaneous Epiduroscopic Techniques through sacral canal under fluoroscopic guide. The Caudal Epidurogram showed restriction in spread of contrast caused by stenosis level both in axial, and or foraminal obstruction. That is important for determination the level of stenosis was seen by fluoroscope, until complete the procedure with adequate visualization of all stenosing level in axial plus foraminal in the lumbar canal stenosis. Using pressurized saline with dye for observational under fluoroscope.
Outcome: The disorders have been confirmed clinically, radiologically, plus by Interventional
Epiduroscopic Technique. Will Improved the diagnosis, plus improvement in the treatment orientation of decompression level of Lumbar Canal Stenosis.
Results: The Epiduroscopic techniques in all lumbar spinal canal stenosis patients has led to exclusion 14 patients from original 40 patients that they were selected randomly. The early preliminary Epiduroscopic before the decompression for those patients under gone decompression laminectomy of the lumbar canal stenosis patients will lead immediately to improvement in the canal opening visualized in the epidurogram, without any eliminate of stenosis or obstruction both in axial, plus foraminal direction. That improvements post Epiduroscopic technique were tethering of the roots intraoperative seen, supporting the clinical, plus radiological Magnetic Resonance Image MRI data. The outcome was noticed with significant improvement in the mean of Stanford score and ODI (Oswestry low back disability score) from baseline at follow up visit for 6,12,24 Months according to Sciatica Pain, Functional Outcome, return back to work, Psychological status, Change in Narcotic intake, with the General Satisfaction rate. Revealed high outcome results in the diagnosis, plus managements, with minimal interventional procedure, minimal complications rate in lumbar canal stenosis patients.
Conclusion: We concluded that Percutaneous Epiduroscopic Techniques for 2 years follow up using in the spinal canal stenosis of degenerative origin patients can improve the diagnosis plus managements is superior to the immediate surgical exploration with decompression laminectomy alone in these groups of patients.
