Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan.
Department of Orthopedics, Higashiosaka Medical Center, Osaka 578-8588, Japan.
Tomography. 2023 Jan 30;9(1):285-298. doi: 10.3390/tomography9010023.
The loss of resistance (LOR) method has been used exclusively to identify epidural space. It is difficult to find the epidural space without the risk of dural puncture. Various devices have been developed to improve the accuracy of the LOR method; however, no method has overcome the problems completely. Therefore, we devised a ligamentum flavum rupture method (LFRM) in which the needle tip is placed only on the ligamentum flavum during the epidural injection, and the injection pressure is used to rupture the ligamentum flavum and spread the drug into the epidural space. We confirmed the accuracy of this method using ultrasound with superb microvascular imaging (SMI) to visualize the epidural space. Here, we report two cases of 63-year-old and 90-year-old males. The 63-year-old patient presented with severe pain in his right buttock that extended to the posterior lower leg. The 90-year-old patient presented with intermittent claudication every 10 min. LFRM was performed, and SMI was used to confirm that the parenteral solution had spread into the epidural space. Our results indicate that LFRM can be used for interlaminar lumbar epidural steroid injections.
阻力消失（LOR）法已被专门用于识别硬膜外间隙。如果没有刺破硬脑膜的风险，很难找到硬膜外间隙。已经开发了各种设备来提高 LOR 方法的准确性；然而，没有一种方法能够完全克服这些问题。因此，我们设计了一种黄韧带破裂法（LFRM），在硬膜外注射时，针尖仅放置在黄韧带上，然后利用注射压力使黄韧带破裂，将药物扩散到硬膜外间隙。我们使用超声 superb microvascular imaging（SMI）来可视化硬膜外间隙，证实了这种方法的准确性。在这里，我们报告了两例 63 岁和 90 岁男性患者的病例。63 岁的患者右侧臀部剧烈疼痛，向后小腿延伸。90 岁的患者每 10 分钟间歇性跛行一次。进行了 LFRM，并使用 SMI 确认了鞘内溶液已扩散到硬膜外间隙。我们的结果表明，LFRM 可用于椎间腰椎硬膜外类固醇注射。
