1. Back or neck pain, with or without radicular pain of chronic duration
2. Unresponsiveness to conservative therapy
3. Lack of obvious source of pain pathology
A good rule of thumb is to consider that the presence of a focal neurological deficit requires surgical decompression until another diagnosis is reached, while pain alone suggests a more conservative approach of injection therapy such as epidurolysis. This assumes that loss of function (focal neurological deficit) is most often due to compression while pain is most often inflammation. A compressed nerve root can be further compromised, perhaps permanently, with the potential barotrauma of an injection into a closed space (Figure 10.3A). Saberski et al. demonstrated that as little as 1 mL of injectate into a closed epidural space can produce 400 mmHg pressure.23 Careful and judicious epidurography can determine the presence of a loculated space that can be decompressed to allow a more normal and safe epidural spread following epidurolysis (Figure 10.3B, C).
Was this article helpful?
This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.