An Overview Of An Epiduroscopy In Pain Management
An epiduroscopy is an outpatient procedure that is minimally invasive utilizing a flexible instrument containing a small camera known as an epiduroscope. The procedure may assist with figuring out the cause of pain in the legs and lower back. This pain often emanates from sciatica. The procedure was first developed in the 1990’s and entails a catheter system that is enhanced with a saline flush system attached to its side.
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 doctor can utilize instruments placed through the catheter to take out some of the scar tissue. This is termed an adhesiolysis and it may decrease pain substantially.
Steroid and/or anesthetic numbing medicine can be placed to relieve pain from inflammation. Once complete, patients can be sent home same day so it’s outpatient. Returning to work should be quick.
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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