Epiduroscopy was developed in the 1990`s. A fibre optic camera is inserted through the sacral hiatus into the lower epidural space, and is then guided upwards towards the lower lumbar discs and nerve roots.
Epiduroscopy has two main uses in the pain clinic:-
- Releasing epidural adhesions for the relief of chronic sciatica. Adhesions can form around the lower lumbar nerve roots after decompressive surgery for disc disease, or after a bad bout of inflammatory sciatica in the absence of surgery. Epidural adhesions can usually be identified on an enhanced MRI scan using intravenous gadolinium. They also cause uneven spread of X-ray contrast when performing an epidurogram.
- Injecting mixtures of local anaesthetic and depot steroid around inflamed nerve roots when epidural injections / nerve root blocks have been unsuccessful. The presence of adhesions can prevent epidurally injected drugs from reaching the inflamed nerve roots.
- The procedure is performed in the face-down position, under intravenous sedation and local anaesthesia, whilst using X-ray screening in an operating theatre to minimise infection.
- Local anaesthetic is injected in and around the sacral hiatus to numb the area. A small needle is inserted through the sacral (caudal) hiatus into the epidural space. Through this needle is then passed a fine metal guide wire. The small needle is then removed leaving the guide wire in place in the epidural space. A series of dilators are then passed over the guide wire until the sacral membrane will accept a sheath cannula (see diagram above). Once the sheath is in place, the guide wire is removed.
- A steerable catheter attached to a fibreoptic epiduroscope is then inserted through the centre of the sheath until it enters the epidural space. Passage of the steerable catheter is enhanced by using a saline flush system attached to a side port on the sheath.
- The fibreoptic epiduroscope is then advanced upwards using X-ray guidance, until it reaches the area where Epidural Adhesions have been found on an MRI scan
- Once in the correct area, epidural adhesions can be gently broken down using the Epiduroscope Tip . Afterwards, local anaesthetic and depot steroid can be injected around any inflamed nerve roots in the area.