Wagner K J, Sprenger T, Pecho C, Kochs E F, Tölle T R, Berthele A, Gerdesmeyer L
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2006 Apr;41(4):213-22. doi: 10.1055/s-2006-925232.
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.
拉茨的微创硬膜外导管置入术，也被称为“硬膜外神经成形术”，不仅用于脊柱手术失败的患者（“失败的脊柱手术综合征”），而且越来越多地应用于非手术性背痛患者，以防止病情慢性化或恶化。其假定的作用原理是通过反复注射局部麻醉剂、皮质类固醇、透明质酸酶和高渗盐溶液，在硬膜外局部溶解粘连、对脊神经根进行神经松解以及局部冲洗促炎介质。然而，硬膜外神经成形术中已知会发生不良事件。硬膜外神经成形术的并发症是由于手术本身或特定药物相关的副作用所致。意外硬膜穿刺、将药物注入蛛网膜下腔或硬膜下腔、导管剪切、感染以及应用过程中严重的血流动力学不稳定是最常见的不良事件。与手术本身相关的并发症立即发生，而与药物给药相关的并发症则出现较晚。在此背景下，我们报告一例因非特异性下背痛接受拉茨导管治疗的患者发生严重脑膜炎并伴有神经后遗症的病例，并概述有关其他潜在严重并发症的文献。因此，我们建议拉茨导管手术目前应仅限于具有严格纳入和排除标准的对照临床试验。
