Background
The American Academy of Orthopedic Medicine estimates the total annual cost to society from low back pain is $100 billion, including $20 billion in direct patient medical bills. With the aging of the U.S. population, these numbers will only grow.
Treating the spine in a minimally invasive manner is not a new idea. Dr. Michael Burman first investigated the use of endoscopes in the epidural space in 1931 when he removed eleven vertebral columns from cadavers and examined them using rigid urology endoscopes. He concluded that the procedure had tremendous potential, however, technology at the time did not make it practical.
The following list demonstrates some of the abnormal pathology that can be identified by epiduroscopy: scar tissues and adhesions, hypertrophied, ligamentum flavum, herniated nucleus pulposus, epidural cysts, and neuritis. In the future, as this technology evolves, patients needing more aggresive therapeutic procedures such as laser neuroplasty, discectomy, and partial laminectomy may be able to be treated in the minimally invasive manner.
Dr. Richard Deyo, principal investigator for the U.S. Public Health Service, who headed up the Back Pain Outcome Assessment Team, states that most backaches are caused by soft tissues that do not show up on X-ray, CT scans, and MRI. Studies at George Washington Medical Center concluded that CAT scans and MRI can be misleading. They performed MRI's on 67 people who had no history of low back pain and these studies showed bulging or degenerated discs in 35% of the younger patients and in essentially all of the older patients. These studies should lead practitioners to question why the majority of low back pain patients are routinely subjected to the expense of these imaging technologies when only 1-2% of this population are candidates for surgical intervention.
The epiduroscope is actually a catheter with two channels. One channel is for fluid and one channel is for the fiber optic fiber which is 0.9mm in diameter. (IMAGE 1)
How is it placed?
The scope is placed (while the patient is under sedation) via the caudal canal (IMAGES 2 & 3) which is an opening in the tail bone that connects to the epidural space. A catheter is placed and the scope is advanced through it.
What do you see?
View Via Scope
During Epiduroscopy, Dura or the covering of the spinal cord (IMAGE 6)can be seen as well as Epidural fat which becomes inflamed and tough if there is inflammation. Adhesions and inflamed nerves can be seen.
What does the Scope do? (IMAGE 5)
The scope allows for clearance of adhesions and visualization of inflamed nerves and adhesions. X-ray is also used to guide the scope at the same time, as epiduroscopy is performed.
During the use of the scope, fluid is used to open the epidural space to be seen, as well as to wash out toxins.
How is it done?
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The scope can be bent in any direction and moved in or out, thus clearing adhesions, releasing trapped nerves. The scope is also delivering water as the procedure is performed, clearing and washing out substances held in place by adhesions that irritate nerves, causing pain. | |
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What
are the possible complications?
Besides the usual complications, Nerve Trauma is possible, since the nerves
are being cleaned off. That is why the patient is awake during the time
of the procedure, to prevent injury. There is a small increase in the
possibility of a dural tear. Also the fluid given via the scope may lead
to a headache, which usually stops in 3-4 hours. This is another reason
the patient is kept awake - if a headache starts, the procedure can
be safely stopped.
IMAGE 2
IMAGE 3
IMAGE 4
IMAGE 5
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