Since 2000s, in the early days of SELD, some reports have suggested its clinical application in various lumbar spinal diseases to not only disc herniation but also adhesion or fibrosis around nerve roots, failed back surgery, and even spinal stenosis. After that, alongside small-caliber flexible optics and light sources, video-guided catheter and video systems, and laser technology, the present trans-sacral epiduroscopic decompression (SELD) technique was developed to treat the symptomatic pathology of the lumbosacral spine. In 1996, the United States Food and Drug Administration eventually approved Myelotec Myeloscopy (Myelotec, Inc., Great Neck, NY), a modern epiduroscopic technique via the sacral hiatus, to visualize and treat spinal epidural pathology.

After that, in the 1990s, researchers, including Leu and Shutse et al., reported on the clinical usefulness and outcomes of epiduroscopy for the treatment of spinal disease. Since the late 1960s, several pioneers, including Saberski, Ooi, Blomberg, Olsson, Holstrom, and Mollmann et al., developed the concept of spinal epiduroscopy through conducting human autopsies of the spine, and they reported on the clinical use of endoscopy via the sacral hiatus approach. Burman introduced the concept of epiduroscopy in 1931, and Stern first used clinical epiduroscopy for the diagnosis of various epidural lesions, including disc herniation, neuritis, and venous congestion. The first real endoscope was invented by Adolf Kussmaul in 1868, which led to the milestone development of a flexible fiberglass endoscope in 1958 by Hirschowitz. It permits various clinical applications in the epidural space of the lumbosacral spine, such as epidural catheter placement and diagnosis, decompression of disc herniation, epidural adhesiolysis, delivery of epidural drug agents, and spinal cord stimulation electrode implants.Įpiduroscopy has been steadily and dramatically developed over the last century, achieving various milestones during the epiduroscopic surgery era. IntroductionĮpiduroscopy, also known as epidural spinal endoscopy, is defined as the percutaneous minimally invasive investigation of the epidural space with the assistance of a flexible endoscope through the sacral hiatus. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD. Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies.

The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. According to Odom’s criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up ( ). Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom’s criteria. A retrospective review of clinical data was conducted. Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Therefore, the authors investigated patients undergoing SELD to report the clinical results. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. ThePlayaJam: Map designer of the GMOD version of The Eight Pages.Objective. Mark J Hadley: Creator of the game that started it all. See if you can figure out which locations these are. I had to have 4 locations share page group 1 and 2. Since I can only split the pages into eight categories otherwise the gamemode will think there are 10 of them to collect. Search all 10 to make sure you get them all.

I don't know what made me do this, but I have been feeling the urge to create some slender maps lately.Īctual dark skybox extracted from Slender v0.9.7ġ0 different locations that may or may not contain a page. This map was built specifically with Stop it Slender! in mind! So if you run a Stop it Slender! gamemode server, add this to the list of maps. This map is a GMOD recreation of the game that started it all: Slender: The Eight Pages PLEASE READ THE DESCRIPTION! DON'T GET CAUGHT ON 7 PAGES!

Slender the eight pages 0.3.1