Evaluation of reliability and safety of targeted treatments via epiduroscopy and their use in clinical applications.

1)硬膜外镜治疗腰椎疾病引起的顽固性下肢疼痛的有效性和安全性评价。根据日本骨科协会（JOAscore）制定的评估评分和在治疗患者中进行的术后调查，发现硬膜外粘连和/或神经根粘连溶解的硬膜外镜神经根成形术对18例腰椎疾病引起的顽固性下背部和肢体疼痛患者具有长期有效性。2）神经根成形术对感觉神经功能的影响：采用神经功能测定仪（Neurometer）检测Aβ、Aδ和C纤维的电流感知阈值（CPT），观察硬膜外镜对神经根的压力释放或牵拉对神经功能的影响。在2000 Hz（Aβ纤维）时，硬膜外镜手术使神经功能由麻痹恢复正常，证明硬膜外镜确实减轻了对压力最敏感的Aβ纤维的压力或牵拉。此外，硬膜外镜实际上到达神经根的事实为选择性地施用药物提供了可能性，尽管这些药物可能限于不刺激局部组织或没有神经毒性的药物。3）在本研究中，由于时间限制，没有进行动物实验。

1)Evaluation of usefulness and safety of epiduroscopy against intractable lower back and limb pain caused by lumbar diseases. Epiduroscopy radiculoplasty that lyses of epidural adhesion and/or nerve root adhesion was found to have long-lasting effectiveness on 18 patients suffering from intractable lower back and limb pain caused by lumbar diseases, which was established based on evaluation scores developed by the Japanese Orthopaedic Association (JOAscore) and a post-operative survey conducted among the treated patients. Safety of the operations was confirmed with the absence of complications among the patients.2)Effects of radiculoplasty on sensory nerve functions.Current perception threshold (CPT) tests using Neurometer that can differentiate functions of Aβ,Aδ, and C fibers were performed to examine how epiduroscopy would affect the nerve functions by releasing pressure or traction present on the nerve roots. At 2000Hz that corresponds to Aβ fibers, the epiduroscopic operation improved the nerve function from torpor to normal, which proved epiduroscopy indeed alleviate such pressure or traction on the Aβ fiber that is usually most susceptible to pressure. Further, the fact that epiduroscopy actually reaches the nerve root opens a possibility to selectively administer drugs, albeit such drugs may be limited to those that do not irritate local tissue or those without neurotoxicity.3)In the present study, no animal experiment was performed due to time constraints.