An epiduroscopy is a minimally invasive procedure that uses a flexible instrument containing a tiny camera known as an epiduroscope. The procedure is performed to diagnose the cause of pain in the lower spine and legs. The pain is often the result of sciatica. Epiduroscopy was developed in the 1990's and involves and involves a steerable catheter system enhanced by a saline flush system that is attached to a side port on the sheath.
During the procedure, the pain doctor often administers medication to treat the pain. IN preparation for the procedure, the patient is positioned with appropriate padding and the patient is given local anesthesia. The doctor utilizes x-ray fluoroscopy during the procedure to hopefully ensure accurate placement of the camera.
Once the problem area is located on the fluoroscopy, a small incision is made through which a catheter is inserted containing the epiduroscope. The scope is inserted through the sacrococcygeal membrane to allow direct visualization of the epidural space.
The scope contains a fiberoptic camera which enables visualization of damage and scar tissue on the spine which may be causing sciatica. Adhesions can be visualized, nerve roots may be inspected and the specific areas of inflammation hopefully identified. A small needle is placed through the sacral hiatus into the epidural area. Through this a small metal guide wire is positioned. The doctor then removes the small needle which then leaves the guide wire in place. A series of dilators are then passed over the guide wire and once a large enough space is created, the sheath cannula is positioned.
The physician may use instruments inserted through the catheter to break down some of this scar tissue. This is called an adhesiolysis and it can dramatically reduce a patient's pain.
Anesthetic or corticosteroid medication may also be injected to relieve pain from inflammation. Once the procedure is complete, patients may be discharged same day making it an outpatient procedure. Getting back to work should be within a few days.
Complications can occur during an epidurolysis. When a significantly sized camera is placed near a nerve root, the root can be injured. A dural tear may occur if the epiduroscope makes a small hole in the dural membrane. This can cause a post dural puncture spinal headache.
One additional complication that may be seen is a macular hemorrhage. This is bleeding in the internal layers of the eye. If excessive flush is used during the procedure, a rapid rise in cerebral pressure may occur and cause this complication.
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