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Epidural Lavage and Nerve Block (X-Ray-Guided)

  • Kumiko HidaEmail author
  • Maya Hayashi
Chapter

Abstract

Epidural lavage and nerve block are minimally invasive techniques for the treatment of lumbar radiculopathy. This technique involves accessing the epidural space via the sacral hiatus and inserting a catheter. The catheter is advanced to the site adjacent to the nerve roots considered responsible for the patient’s symptoms, and then a radiopaque contrast agent is injected through the catheter, and an X-ray image is taken (epidurography); normal saline up to 40 mL, local anesthetics, and steroids are injected into the space. The proposed mechanisms of added volume include not only washout of inflammatory cytokines but also lavage of the epidural space, suppression of ectopic discharge from injured nerves, and enhanced blood flow to ischemic nerve roots. This technique exists between epidural lysis of adhesions (epidural neuroplasty and epidural adhesiolysis) and conventional epidural steroid injections.

Keywords

Epidurography Epidural steroid injection Epidural lavage 

References

  1. 1.
    Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural lysis of adhesions. Korean J Pain. 2014;27:3–15.CrossRefGoogle Scholar
  2. 2.
    Scuderi GJ, Brusovanik GV, Anderson DG, Dunham CJ, Vaccaro AR, Demeo RF, Hallab N. Cytokine assay of the epidural space lavage in patients with lumbar intervertebral disk herniation and radiculopathy. J Spinal Disord Tech. 2006;19:266–9.CrossRefGoogle Scholar
  3. 3.
    Hsu E, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP. Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome. Anesth Analg. 2014;118:215–24.  https://doi.org/10.1213/ANE.0000000000000042.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyNagasaki University School of MedicineNagasakiJapan
  2. 2.PainClinic, NTT Medical Center TokyoTokyoJapan

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