How we can see and treat the epidural space: Epiduroscopy

Low back pain (LBP) syndromes represent a heterogeneous category of pathology, such as the failed back surgery syndrome (FBSS). LBP treatment includes conservative and interventional procedures, with high costs and low efficacy in most cases. Epiduroscopy has been revalued only recently for the treatment of LBP. The procedure was first performed using a percutaneous approach, which is still used with efficacy for LBP and/or radiculopathy. The classic epiduroscopy procedure, however, has a great limitation, because it uses only liquids to visualize the dura space, and it can not overcome fibrotic obstructions of the channel. Because of these limitations, we introduced a new epiduroscopy technique, which allows a direct visualization of the dura during the lysis, and reduces the risks related to the procedure.We performed a literature review of the percutaneous approach and compared it to our experience with Resaflex and Resascope for epidurolysis, in order to assess the therapeutic benefits of the two methods, and their role in the study of dura morphological components in FBSS.Percutaneous adhesiolysis and our endoscopic method showed similar efficacy level, however, the Resascope resulted in less complications and a better lysis. Since our endoscopic method proved to be safe and repeatable for the treatment of FBSS and the study of normal and pathological morphologies of the dura with direct imaging, we suggest using it as first choice in patients suffering from FBSS.     

Genital foreign bodies: more than the eye can see.

Genital foreign bodies constitute a diverse but surprisingly common means of presentation to emergency departments. Although the presentation usually means the initial diagnosis is easily made, we present a case here that stresses the importance of attention to history, clinical examination and radiological investigation. A 44-year-old gentleman presented with a history of pain and discharge from a self-inflicted scrotal wound. Further questioning revealed a history of genital foreign bodies, but the full extent of his condition was not apparent until plain pelvic radiographs were obtained. The initial management of genital foreign bodies follows basic surgical principles. Constricting bands must be removed, devitalized tissues debrided and the surgical field extensively irrigated. Underlying psychiatric illness may be present and a high index of suspicion is required in the initial assessment of such patients. A plain pelvic radiograph is recommended to fully identify all foreign bodies present.     

Motorcyclists,full-face helmets and neck injuries: can you take the helmet off safely,and if so,how?

Injured motorcyclists may have a damaged and unstable cervical spine (C-spine). This paper looks at whether a helmet can be safely removed, how and when should this be done? The literature is reviewed and the recommendations of the Trauma Working party of the Joint Colleges Ambulance Liaison Committee are presented.