| Epiduroscopy is the placement of an endoscope from the tailbone into the spine to assist in breaking up epidural scar tissue (adhesions) in the lower lumbar spine. The scar tissue is composed of fibrous bands which may be viewed directly through the endoscope and broken up mechanically, chemically, or even with a laser fired through the endoscope. The procedure is an outpatient procedure but has some significant risks associated such as injury to nerves, spinal cord, dura, infection, development of a hematoma (blood clots), and retinal detachment. Most of the above are very rare. While the purpose of the epiduroscope is to observe scar tissue and when possible, use the tip of the scope to help break up scar, the scope may also be used to deliver medications such as steroids and enzymes which may help dissolve scar tissue. Epiduroscopy uses caudal canal entry to the epidural space. The sacrococcygeal ligament is entered with a needle and a guide wire placed through the needle enters the epidural space. A dilator and sheath are placed over the guide wire, and the scope is placed through the sheath. Usually the scope can be advanced as far as the L3 level. Epiduroscopy is taught in only a few pain fellowship programs nationwide, has had FDA 510K Clearance since the mid 1990s, and is used by approximately 2% of pain physicians. It requires significant skills beyond those of an injectionist. Alternatives to epiduroscopy include Navicath or the Racz procedures. Both of these procedures use the same approach as epiduroscopy but use a fluoroscopically guided lysis of adhesions instead of endoscopic. This means the scar tissue is not actually visualized directly but is seen by combining epidurography with the mechanical and chemical breakage of adhesions. The Navicath is a semi-rigid flexible and steerable plastic catheter which is used to break up scar tissue. The Racz procedure uses a semi-rigid teflon coated wire wound catheter to achieve the same effect. The Navicath is stiffer than the Racz catheter and can be used to break up denser scar tissue. Navicath is not taught in pain management fellowships and has FDA 510K approval. It has been available since about 2002. Racz catheters have been available since the mid 1990s and have 510K approval. The Racz procedure is taught in a few pain fellowships and is used by about 4% of pain physicians- those with advanced skills |
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| Click on pics below to enlarge |
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| Epiduroscopy and Lysis of Adhesions |
