The 68th
Scientific Meeting
초록접수 미리보기
| 19S-051 |
Using a balloon catheter for epidural adhesiolysis to implant
a spinal cord stimulator device: a case report
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Complex regional pain syndromes (CRPS) are neuropathic pain disorders developing as a disproportionate consequence of painful trauma, a nerve lesion affecting the limbs, or a bone fracture. Implantation of a spinal cord stimulator (SCS) is an evidencethic pain, including CRPS. We describe our experience where SCS was successfully reimplanted after epidural adhesiolysis using a balloon catheter.
A 60-year-old woman presented with a medical history of a right foot ligament tear after an accidental step down from the bus. She was managed medically for 2 months followed by a modified Brostrom operation on the right foot, and her pain persisted after this surgery for 10 months. After history taking, physical examination, and diagnostic assessments including quantitative sudomotor axon reflex test and three-phase bone scan and thermography, she was diagnosed with CRPS. On August 2018, we tested her with a spinal cord stimulator, her ankle pain was well-controlled. A week later, we implanted permanent SCS at T9-10 level. On postoperative day 5, the patient had a fever with local infection signs showing wound dehiscence and pus discharge. In spite of wound revision with administration of intravenous antibiotics wound infection was recurred therefore we decided to remove the SCS device on postoperative day 155. Two months later, when we tried to insert an SCS electrode again, it was hard to advance the SCS electrode above the T11 level in the epidural space, due to epidural adhesions. To implant the SCS electrode between the T10 and T11 level in the epidural space, we used a balloon catheter (Fig 1) and implanted a round-type stimulator successfully. The new generator device was repositioned on the left lower abdominal region and new lead extenders were then subcutaneously tunneled on the left lumbar area (Fig 2). There were no postoperative complications and the patient was discharged in good physical condition with reduction of pain.
Epidural adhesions are often caused by surgical intervention, including SCS implantation. We presented a case where a CRPS patient who had epidural adhesions and a wound infection after SCS implantation. The present case suggests that an inflatable balloon catheter may be an effective method to perform epidural adhesiolysis when an SCS electrode fails to be inserted in epidural space.
A 60-year-old woman presented with a medical history of a right foot ligament tear after an accidental step down from the bus. She was managed medically for 2 months followed by a modified Brostrom operation on the right foot, and her pain persisted after this surgery for 10 months. After history taking, physical examination, and diagnostic assessments including quantitative sudomotor axon reflex test and three-phase bone scan and thermography, she was diagnosed with CRPS. On August 2018, we tested her with a spinal cord stimulator, her ankle pain was well-controlled. A week later, we implanted permanent SCS at T9-10 level. On postoperative day 5, the patient had a fever with local infection signs showing wound dehiscence and pus discharge. In spite of wound revision with administration of intravenous antibiotics wound infection was recurred therefore we decided to remove the SCS device on postoperative day 155. Two months later, when we tried to insert an SCS electrode again, it was hard to advance the SCS electrode above the T11 level in the epidural space, due to epidural adhesions. To implant the SCS electrode between the T10 and T11 level in the epidural space, we used a balloon catheter (Fig 1) and implanted a round-type stimulator successfully. The new generator device was repositioned on the left lower abdominal region and new lead extenders were then subcutaneously tunneled on the left lumbar area (Fig 2). There were no postoperative complications and the patient was discharged in good physical condition with reduction of pain.
Epidural adhesions are often caused by surgical intervention, including SCS implantation. We presented a case where a CRPS patient who had epidural adhesions and a wound infection after SCS implantation. The present case suggests that an inflatable balloon catheter may be an effective method to perform epidural adhesiolysis when an SCS electrode fails to be inserted in epidural space.
|
|
