Epiduroscopy

 

Epiduroscopy is the placement of an endoscope from the tailbone into the spine to assist  in breaking up epidural scar tissue (adhesions) in the lower lumbar spine.  The scar  tissue is composed of fibrous bands which may be viewed directly through the
endoscope and broken up mechanically, chemically, or even with a laser fired through
the endoscope.  The procedure is an outpatient procedure but has some significant risks  associated such as injury to nerves, spinal cord, dura, infection, development of a hematoma (blood clots), and retinal detachment.  Most of the above are very rare.  While  the purpose of the epiduroscope is to observe scar tissue and when possible, use the tip  of the scope to help break up scar, the scope may also be used to deliver medications  such as steroids and enzymes which may help dissolve scar tissue.   Epiduroscopy uses caudal canal entry to the epidural space.  The
sacrococcygeal ligament is entered with a needle and a guide wire placed through the needle enters the epidural space.  A dilator and sheath are placed over the guide wire, and the scope is placed through the sheath.  Usually the scope can be advanced as far as the L3 level.

 

What is epiduroscopy/adhesiolysis?
Epiduroscopy is a method of directly visualizing and potentially treating pain generators inside of the spinal column.  A small flexible fiberoptic catheter is inserted through a tiny incision and the areas of concern can be visualized on a video monitor.  Medication can then be injected through the same catheter. An epiduroscopy involves looking inside the epidural space (see epidural injections). Inside your vertebral column there is a space containing the spinal cord. Cerebrospinal fluid surrounds this spinal cord which in turn is surrounded by a strong membrane called the dura (see epidural injections).

Surrounding this strong membrane is another space called the epidural space. Looking inside this space is called an epiduroscopy. The epidural space contains nerves that connect the spinal cord to the rest of the body (see epidural injections).

Using an epiduroscope, a special scope which has a camera attached to a catheter, we can look inside the epidural space. This catheter is inserted into the epidural space through an opening in the sacrum (near the tail bone).

 

 

What are the main uses of epiduroscopy/adhesiolysis?
Adhesions, or scar tissue, that may be pulling on or irritating specific nerve roots can sometimes be effectively stretched or loosened using this device.  By so doing, steroids injected through the catheter can be more effective.

 

Who benefits from epiduroscopy/adhesiolysis?
Anyone with low back pain or sciatic and a history of an inflamed disc or prior surgery can potentially benefit.


What do we see with epiduroscopy?

The epiduroscopy can be used to see what problems there might be with regard to the nerve roots and/or surrounding tissue such as fat.

We can see whether or not the nerve roots are inflamed and whether there is any scar tissue or inflamed fat tissue present.

 

When do I need an epiduroscopy?

If you have lower back pain, with or without radiation to one or both legs, that has not responded to other means of treatment then your pain physician may decide to perform an epiduroscopy on you

 

What is epiduroscopy supposed to treat?

Apart from allowing the doctor to see what the problem is, epiduroscopy can also be used as a means of treatment. As a result of scar formation there may be adhesions around the nerve root that can be released.

In an epiduroscopy drugs are injected into the area around an inflamed nerve root.

If substances have been released by the intervertebral disc then these can irritate the nerve root. These irritants can be removed by rinsing.

An epiduroscopy can also be used to partly remove small nerve fibres from the nerve roots.

 

What should I be aware of before undergoing an epiduroscopy?

Any of the following situations should be reported to your pain specialist if he proposes epiduroscopy:

If you are pregnant: since X-ray equipment is used, pregnant women may not undergo epiduroscopy.

If you are ill or have a fever on the day of treatment you cannot undergo epiduroscopy, in which case a new appointment will have to be made.

If you are allergic to iodine, plasters, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.

If you are taking blood thinners, you should notify that your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.

 

How should I prepare for epiduroscopy?

The treatment will take place in a day-care centre.

You will be asked not to eat or drink after midnight on the day before treatment.

 

How does epiduroscopy work?

After you have reported to the surgical day-care centre, you will be escorted to the operating theatre.

There, you will be placed on a bed and prepared for epiduroscopy.

After a drip has been inserted and the necessary monitoring equipment (heart rate, blood pressure) put in place, you will be asked to lie on your stomach.

The treatment is performed under local anaesthesia, possibly with the addition of a mild sedative to ensure that you are calm and relaxed.

A scope will be inserted after a local anaesthetic has been applied at the level of the coccyx.

During the procedure, you will sometimes be asked questions. You will also be asked to report immediately report if you feel anything in particular, such as a headache or neck pain.

During epiduroscopy, a sterile fluid is injected into the epidural space (see epidural injections), which will remain in this space.

The amount of fluid is constantly monitored, as is the pressure in the epidural space.

Fluoroscopy is used to ensure that the scope is in the correct position.

The treatment is recorded on video.

As a protection against infection, some form of antibiotic will be administered by means of a drip.

The treatment will takes approximately one hour.

After treatment you will be taken to the recovery room.

You will remain there for further controls for about four hours.

 

When will I be discharged from hospital?

Before you are discharged, the treating pain specialist will give you the results of the epiduroscopy.

Since local anaesthetics have been used, there can be decreased strength and numbness in the legs, resulting in diminished coordination.

You must therefore ensure that you have someone to take you home.

On the day of treatment, you should take it easy and are advised not to drive for the first 24 hours after treatment.

 

What after care is necessary?

Since the effects of treatment can be expected to last for several months, the first control appointment will be made at three months after the procedure. Thereafter, additional control appointments will be scheduled for 6, 12 and 24 months after the procedure.

 

What are dangers and side effects of epiduroscopy?

As in the case of all examinations/treatments, epiduroscopy can cause side effects. The most serious of these occur during or directly after treatment.

During treatment, you may experience complaints such as headache, neck pain or pins and needles in the legs.

If the complaints become serious, treatment will be halted.

After the procedure, you may feel side effects when you are seated. About 10% of patients experience temporary headaches.

Infection and bleeding after the procedure are rare.

If you experience headaches, neck pain or fever, you should contact the pain clinic without delay for further treatment of these complaints.