Lumbar Epiduroscopy

  • Chapter
  • First Online:
Minimally Invasive Spine Intervention

Abstract

Modern pain therapy for chronic spinal pain syndromes can only be effective if the cause of the pain is clearly and unequivocally identified. However, the diagnosis and therapy of chronic spinal pain syndromes is complex and a lasting therapeutic success is difficult to achieve. For a large number of patients with spinal pain syndromes, endoscopic examination (epiduroscopy) is considered a diagnostic hope in pain medicine; it also represents a promising therapeutic perspective. Interventional pain therapy is becoming increasingly important in diagnosis and therapy. The spinal interventional diagnostic and therapeutic procedures presented in this chapter represent a valuable opportunity to improve the treatment of patients with chronic pain syndromes when patient selection and indications are accurate. In this chapter, the percutaneous, flexible endoscopic examination technique (spinal endoscopy, epiduroscopy, EDS) is presented exclusively in the lumbar spine of the pain patient. Spinal endoscopy is not a last resort for selected pain patients, but an important component of the diagnosis and therapy of chronic spinal pain syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 117.69
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
EUR 117.69
Price includes VAT (Germany)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
EUR 160.49
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Bartynski WS, Petropoulou KA (2007) The MR imaging features and clinical correlates in low back pain-related syndroms. Magn Reson Imaging Clin N Am 25:137–154

    Article  Google Scholar 

  • Blomberg RG (1985) A method for spinal canal endoscopy and spinaloscopy: presentation of preliminary results. Acta Anaesthesiol Scand 21:113–116

    Article  Google Scholar 

  • Bosscher HA, Heavner J (2012a) Incidence and serverity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract 10:18–24

    Article  Google Scholar 

  • Bosscher HA, Heavner JE (2012b) Diagnosis of the vertebral level from which low back or leg pain originates. A comparison of clinical evaluation, MRI and epiduroscopy. Pain Pract 12(7):506–512

    Article  PubMed  Google Scholar 

  • Bosscher HA, Heavner JE (2014) Lumbosacral epiduroscopy findings predict treatment outcome. Pain Pract 14(6):506–514

    Article  PubMed  Google Scholar 

  • Burman MS (1931) Myeloscopy or the direct visualisation of the spinal canal and ist contents. J Bone Joint Surg 13:695–696

    Google Scholar 

  • Burton CV (1978) Lumbosacral arachnoiditis. Spine 3(1):24–30

    Article  CAS  PubMed  Google Scholar 

  • Cornefjord M et al (1996) Mechanical and biochemical injury of spinal nerve roots: a morphological and neurophysiological study. Eur Spine J 5:187–192

    Article  CAS  PubMed  Google Scholar 

  • Day PL (2001) The adhesive arachnoiditis syndrome. http://www.cofwa.org/aasyndrome-10-03.pdf. Accessed on 14.08.2018

  • Devor M (1991) Neuropathic pain and and injured nerve: peripheral mechanisms. Br Med Bull 47:619–630

    Article  CAS  PubMed  Google Scholar 

  • diZerga GS (1997) Biochemical events in in peritoneal tissue repair. Eur J Surg Suppl 577:10–16

    Google Scholar 

  • Farrokhi MR et al (2011) The effect of methylene blue on peridural fibrosis formation after laminectomy in rats: an experimental novel study. Spine J 11:147–152

    Article  PubMed  Google Scholar 

  • Geurts JW et al (2002) Targeted methylprednisolone acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: a prospective, 1-year follow-up study. Reg Anesth Pain Med 27:343–352

    CAS  PubMed  Google Scholar 

  • Gill GG et al (1985) Pedicle fat grafts for the prevention of scar in low-back surgery: a preliminary report on the first 92 cases. Spine (Phila Pa 1976) 10:662–667

    Article  CAS  PubMed  Google Scholar 

  • Graziotti P (2007) DVD epiduroscopy. Spine-aligna pty Ltd, 91 Circle. West Australia, Dalkeith. http://www.ipmnt.net

    Google Scholar 

  • Hayek SM et al (2009) Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome. A systemic review. Pain Physician 12:419–435

    Article  PubMed  Google Scholar 

  • Heavner JE et al (1991) Percutaneous evaluation of the epidural and subarachnoid space with a flexible fiberscope. Reg Anaesth 15:85

    Google Scholar 

  • Hirschowitz BI et al (1958) Demonstration of a new gastroscope, the fiberscope. Gastroenterology 35(1):50. discussion 51–53

    Article  CAS  PubMed  Google Scholar 

  • Holström B et al (1995) Risk of catheter migration during combined spinal epidural block: percutaneous epiduroscopy in autopsy cases. Anesth Analg 80:747–753

    Google Scholar 

  • Howe JF et al (1977) Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain and nerve root compression. Pain 3:24–41

    Article  Google Scholar 

  • Igarashi T et al (2000) The fiberoscopic findings of the epidural space in pregnant women. Clin Invest Anesthesiol 92:1631–1636

    CAS  Google Scholar 

  • Igarashi T et al (2004) Lysis of adhesions end epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis. Br J Anaesth 93(2):181–187

    Article  CAS  PubMed  Google Scholar 

  • Kayama S et al (1996) Incision of the anulus fibrosus induces nerve root morphologic, vascular, and functional changes. An experimental study. Spine 21:2539–2543

    Article  CAS  PubMed  Google Scholar 

  • Kim JD et al (2011) Epiduroscopic laser disc and neural decompression. J Neurosurg Rev 1(S1):14–19

    Google Scholar 

  • Kim DH et al (2017) Epiduroscopy: atlas of procedures, 1. Aufl. Thieme, Janeiro/New York/Stuttgart/Dehli/Rio de Janeiro

    Google Scholar 

  • Kizelshteyn G et al (1991) Epidural baloon catheter system lysing epidural adhesions. Reg Anesth 15(1):87

    Google Scholar 

  • Kobayashi Y et al (2005) Effect of mechanical compression on the lumbar nerve root: localization and changes intraradicular inflammatory cytokines, nitric oxide and cyclooxygenase. Spine (Phila Pa 1976) 30:1699–1705

    Article  PubMed  Google Scholar 

  • Leonhardt H (1971) Histologie und Zytologie des Menschen. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  • Leu H (1993) Percutaneous techniques: decompression and intradiscal laser in discoscopy, external pedicular fixation, percutaneous interbody fusion, peridural endoscopy with discoscopy. In: 12th course of percutaneous endoscopic spinal surgery, Zürich

    Google Scholar 

  • Liakakos T et al (2001) Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances and management Dig Surg 18(4):260–273

    CAS  PubMed  Google Scholar 

  • Manchikanti L (2000) The value and safety of epidural endoscopic adhesiolysis. Am J Anesthisol 2:275–278

    Google Scholar 

  • Manchikanti L et al (1999) Non-endoscopic and endoscopic adhesiolysis in post lumbar mainectomy syndrome: a one year outcome study and cost effectiveness analysis. Pain Physician 2:52–58

    Article  CAS  PubMed  Google Scholar 

  • Manchikanti L et al (2005) [ISRCTN 16558617] a randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extrimity pain. BMC Anesthesiol 5:10

    Article  PubMed  PubMed Central  Google Scholar 

  • Möllmann M et al (1992) Spinaloskopie zur Darstellung von Problemen bei der Anwendung der kontinuierlichen Spinalanästhesie. Anästhesist 41:544–547

    Google Scholar 

  • Olmarker K, Myers RR (1998) Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion. Pain 78:99–105

    Article  Google Scholar 

  • Olmarker K et al (1993) Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine 18:1425–1432

    Article  CAS  PubMed  Google Scholar 

  • Olmarker K et al (1995) Inflammatogenic properties of nucleus pulposus. Spine 20:665–669

    Article  CAS  PubMed  Google Scholar 

  • Olmarker K et al (1996) Ultrastructural changes in spinal nerve roots included by autologous nucleus pulposus. Spine 21:411–414

    Article  CAS  PubMed  Google Scholar 

  • Ooi Y (1981) Myeloscopy. Orthop Trauma Surg 24:659–669

    Google Scholar 

  • Otani K et al (1997) Experimental disc herniation: evaluation of the natural course. Spine 22:2894–2899

    Article  CAS  PubMed  Google Scholar 

  • Park CH, Lee SH (2017) Epidurographic findindings following percutaneous epidural adhesiolysis failed to correlate with level of pain reduction in patientes with lumbar spinal stenosis. Pain Med 18:842–845

    Google Scholar 

  • Parris WCV (1999) What is new and on the horizon in pain management. Am Soc Anesthesiol 63:10

    Google Scholar 

  • Pool JL (1938) Direct visualization of dorsal nerve roots cauda equina by means of a myeloscope. Arch Neurol Psychiatr 39:1308–1312

    Article  Google Scholar 

  • Pospiech J et al (1995) Epidural scar tissue formation after spinal surgery: an experimental study. Eur Spine J 4:213–219

    Article  CAS  PubMed  Google Scholar 

  • Raffaelli W, Righetti D (2005) Surgical radio-frequency epiduroscopy technique (R-res-ablator) and FBSS treatment: preliminary evaluations. Acta Neurochir Suppl 92:121–125

    Article  Google Scholar 

  • Richardson J et al (2001) Spinal endoscopy in chronic low back pain with radiculopathy. A prospective case series. Anaesthesia 56:454–460

    Article  CAS  PubMed  Google Scholar 

  • Robertson JT (1996) Role of epidural fibrosis in the failed back: a review. Eur Spine J 5:52–56

    Article  Google Scholar 

  • Ruetten S et al (2002) Application of Holium YAG laser in epiduroscopy: extended practicabillites in the treatment of chronic back pain syndrome. J Clin Laser Med Surg 20(4):203–206

    Article  CAS  PubMed  Google Scholar 

  • Rydevik B et al (1984) Pathoanatomy and pathophysiology of nerve root compression. Spine 9:7–15

    Article  CAS  PubMed  Google Scholar 

  • Rydevik B et al (1990) Diffusion from the cerebral spinal fluidas a nutritional pathway für spinal nerve roots. Acta Physiol Scand 138:247–248

    Article  CAS  PubMed  Google Scholar 

  • Sabersky LR, Brull SJ (1995) Spinal and epidural endoscopy: a historical review. Yale J Med 68:7

    Google Scholar 

  • Sabersky LR, Kitahata LM (1995) Direct visualization of the lumbosacral epidural space through the sacral hiatus. Anesth Analg 80:839–840

    Google Scholar 

  • Schofferman J et al (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3:400–403

    Article  PubMed  Google Scholar 

  • Schütze G (2000) Techniken und Technologien zur Therapie chronischer Schmerzen. Wissenschaftliche Verlagsabteilung, Aachen, Grünenthal GmbH

    Google Scholar 

  • Schütze G (2004) Epiduroskopie eröffnet neue Wege gegen Rückenschmerzen. Schmerz 4:12–13

    Google Scholar 

  • Schütze G (2006) Epiduroskopie. Ein praxisorientierter Leitfaden zur epiduroskopischen Diagnostik und Therapie rückenmarksnaher Schmerzsyndrome. Pabst Science Publishers, Lengrich

    Google Scholar 

  • Schütze G (2008) Spinal endoscopy – epiduroscopy. Springer, Heidelberg

    Google Scholar 

  • Schütze G (2011) Interventionelles Schmerzmanagement- Bildgestützte Verfahren zur Diagnostik und Therapie rückenmarksnaher Schmerzsyndrome – Spinale Endoskopie, pharmakologische und elektrische Neuromodulation. Uni-Med Verlag, Bremen

    Google Scholar 

  • Schütze G, Kurtze H (1985) Direct observation of the epidural space with a flexible catheter-secured epiduroscopic unit. Reg Anesth 19:85–89

    Google Scholar 

  • Shah RV, Heavner JE (2003) Recognition of the subarachnoid and subdural compartements during epiduroscopy: two cases. Pain Pract 3(4):321–325

    Article  PubMed  Google Scholar 

  • Slipman CW et al (2002) Etiologies of failed back surgery syndrome. Pain Med 3:200–214

    Article  PubMed  Google Scholar 

  • Smith S (2003) The adhesive arachnoiditis syndrome. Circle of friends with Arachnoidits (COFWA). http://cofwa.og/AASYNDROME-10-03.pdf. Accessed on 14.08.2018

  • Stern EL (1936) The spinascope: a new instrument for visualizing the spinal canal and its contents. Med Rec (NY) 143:31–32

    Google Scholar 

  • Thompson JN et al (1995) Pathogenesis and prevention of adhesión formation. Br J Surg 82(1):3–5

    Article  CAS  PubMed  Google Scholar 

  • Wagner K et al (2006) Risks and complications of epdural neurolysis – a review with case reprort. Anesthesiol Intensmed Notfallmed Schmerzther 41:213–222

    Article  CAS  Google Scholar 

  • Yang J et al (2011) Application of liposome-encapsulated hydroxycamptothecin in the prevention of epidural scar formation in New Zealand white rabbits. Spine J 11:218–223

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer-Verlag GmbH Germany, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schultheis, B.C., Schütze, G., Weidle, P.A. (2023). Lumbar Epiduroscopy. In: Jerosch, J. (eds) Minimally Invasive Spine Intervention. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63814-9_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-63814-9_23

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-63813-2

  • Online ISBN: 978-3-662-63814-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation