척추수술 후 통증증후군 환자에서 내시경적 및 비내시경적 경막외 유착용해술에 대한 비교연구

• Published in: Korean journal of anesthesiology Vol. 46; no. 3; pp. 329 - 335
• Main Authors: 이상일, Sang Il Lee, 김경태, Kyoung Tae Kim, 황준구, Jun Ku Hwang
• Format: Journal Article
• Language: Korean
• Published: 대한마취통증의학회(구 대한마취과학회) 30-03-2004; 대한마취통증의학회
• Subjects: adhesiolysis; endoscopic; failed back sugery syndrome; nonendoscopic; 마취과학
• ISSN: 2005-6419; 2005-7563

Background: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion & fibrosis, arachnolditis, neural ancroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammafion & edema. There are two methods of adhesiolysis, endoscopic & hon-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. Methods: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group Ⅱ was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reproceduries and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolystsi. Results: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group Ⅱ at 6 month and duration of pain relief (PAS < 5) was more prolonged in group Ⅱ. One patient in each groups complained skin eruption and pruritus, and one patient of group Ⅱ was proved epidural abscess and one patient of group I complained headache. Conclusion: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect. (Korean J Anesthesiol 2004; 46: 329∼335)