Epiduroscopy or Endoscopy of the Epidural Canal is a visualization technique that is performed percutaneously for the diagnosis and treatment of patients with chronic low back pain.
Access to the epidural space is through the sacral hiatus by means of an introducer.
The objective is to identify pathological structures such as inflamed areas (phlogosis), areas of neo-vascularization, and fibrosis in the epidural canal of the lumbar region (L1-S1). Once identified, treatment is carried out taking advantage of the vision of these structures.
Epiduroscopy has recently been re-evaluated for the diagnosis, and especially for the treatment of radicular pain due to failed back surgery syndrome (FBSS) due to fibrosis.
Which patients should undergo this type of surgical procedure?
Patients who should undergo epiduroscopy are those who have lumbar or radicular pain due to post-laminectomy syndrome (after having undergone surgery they have developed fibrosis in the epidural space causing pain) or those with stenosis or narrowing of the lumbar canal. Both groups of patients can be evaluated for epiduroscopy when other less invasive techniques such as nerve blocks and radiofrequency have been exhausted.
In which cases is it more advisable to proceed with epiduroscopy than with reintervention?
In the indications for which it is proposed: pain due to lumbar stenosis or post-laminectomy syndrome, the epiduroscopy option is normally preferred because it is less aggressive. Reintervention is therefore left for very justified cases in which the structural change is such that there is no possibility of improvement with epiduroscopy.
What are the preoperative indications for epiduroscopy?
It is a technique that is performed with deep sedation, a blood test with coagulation is sufficient.
Are there any contraindications or possible side effects of this type of intervention?
Contraindications: the usual ones in percutaneous techniques. It should be taken into account that due to the increase in pressure in the epidural space due to saline lavage, it is contraindicated in cases in which there is a priori an increase in cerebrospinal fluid pressure.