[Risks and complications of epidural neurolysis -- a review with case report].
Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. Complications of epidural neuroplasty are due to the procedure itself or due to specific drugs-related side effects. Unintended dural puncture, administration of the drugs to the subarachnoid or subdural space, catheter shearing, infection and severe hemodynamic instability during application are most commonly observed adverse events. Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.
Wagner
K J
KJ
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München.
Sprenger
T
T
Pecho
C
C
Kochs
E F
EF
Tölle
T R
TR
Berthele
A
A
Gerdesmeyer
L
L
D000779:Anesthetics, Local / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D002404:Catheterization; D064420:Drug-Related Side Effects and Adverse Reactions; D004388:Dura Mater / Q000293:injuries; D004824:Epidural Space; D006801:Humans; D017116:Low Back Pain / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D012306:Risk; D013126:Spinal Nerve Roots / Q000601:surgery; D013129:Spinal Puncture; D000267:Tissue Adhesions / Q000601:surgery; D017211:Treatment Failure
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004364:Pharmaceutical Preparations