Epiduroscopy: diagnostics and treatment of patients after back surgery

30. 4. 2018

epiduroskopieHave your undergone a surgery or even several surgeries of back but have been still suffering from back pain? The solution may be a unique mini-invasive procedure which, with the use of a special endoscopic camera, will precisely detect the source of pain and make it possible to carry out a gentle and quick treatment. Let us introduce the method of epiduroscopy!

Failed back surgery syndrome
Back pain after a surgery and often even after repeated surgeries may result from the “failed back surgery syndrome” (FBSS). What does it mean? It is a conventional back surgery that was carried out technically and anatomically correctly, but the pain still persists or even new pain appears. Statistically, it occurs in as many as a third of patients after a surgery or, according to other sources, even in 40 percent of such patients. “Epiduroscopy is a proven method for the treatment of a chronic root or radicular back pain with typical radiation into a lower limb. The benefit for the patient is its double effect – diagnostic and virtually immediately curative. This surgery is carried out particularly in patients whose pain is not relieved by conservative therapies, such as rehabilitation, physiotherapy or pharmacotherapy, or who do not want to stand the pain any more”, explains MUDr. Róbert Tirpák, FIPP, chief physician of the Clinic of Mini-invasive and Endoscopic Back Treatment in Prague. 

Cause of pain: epidural fibrosis
The most prevalent cause of pain is epidural fibrosis alias fibrous tissue in the epidural space. In connection with FBSS after a back surgery, this ligament may proliferate and take various forms – from consistent nets or plates to a thick mass filling the epidural space. During epiduroscopy it is possible, due to the introduction of a special endoscope, to visualize the entire space, detect the presence and severity of the fibrosis and treat it immediately. The objective of the treatment is the mechanical removal of the fibrosis (this is called mechanical adhesiolysis) and the treatment of other pathological processes that may irritate or oppress spinal roots, thus causing pain which is a sign of the root (radicular) syndrome.

Reliable and precise diagnostic
The presence of epidural fibrosis is usually detected by means of magnetic resonance imaging (MRI) or computer tomography (CT). The efficiency of epiduroscopy as a diagnostic method is confirmed by the study of the Dutch physicians Dr. Bosscher and Dr. Heavner from 2010, which compares the ability of magnetic resonance imaging and epiduroscopy to detect fibrosis. Epiduroscopy shows a clearly higher efficiency, namely in up to 90 percent of patients with FBSS, as compared to 16 percent of patients in the event of MRI.

How is epiduroscopy performed?
A special needle is inserted into the spinal canal through the natural opening in the sacrum, hiatus sacralis. Through the needle, a thin camera (epiduroscope) of approximately one millimeter in diameter, a laser fiber and other instruments intended for flushing with saline solution and for administering a medicine are subsequently introduced. During the epiduroscopy the patient lies on their stomach and is in light anaesthesia. The procedure takes place with the continuous precise and safe monitoring by a C-arm X-ray device. Mechanical adhesiolysis, i.e. removal of the fibrous tissue, is gently done by laser. If the epidural space is narrowed, a balloon catheter is introduced for the sake of greater clarity and widening of the space. The surgery takes 20 to 60 minutes.

Epiduroscopy_Typické Usporiadanie sály

Scientifically verified methods and their advantages
Epiduroscopy is classified in the category of mini-invasive endoscopic surgeries that are based on the findings of evidence-based medicine (EBM) and recommendations of the international organizations SIS (Spine Intervention Society) and WIP (World Institute of Pain). In this context, experts uphold the position that this type of treatment is not suitable for every patient, that not every patient will feel the same pain relief, and that a mini-invasive procedure is not a better approach for every patient. According to ISMISS (International Society for Minimal Intervention in Spinal Surgery), when compared to conventional treatments, mini-invasive and endoscopic procedures have a lot of clinical benefits for the patient: a lower risk of damage of nerves, lower formation of epidural fibrosis, lower occurrence of infections, a smaller surgical incision and surgical trauma, and quicker recovery and return to work.

EuroPainClinics Study II – a clinical study on epiduroscopy
The benefits of epiduroscopy are the subject of one of the clinical studies that are carried out as part of the scientific research at EuroPainClinics facilities. The study is carried out in two groups of patients and compares the efficiency of the method used when performing the mechanical adhesiolysis alone and when performing the mechanical adhesiolysis supplemented with administration of a medicine to evaluate two important parameters: pain intensity on the Visual Analogue Scale (VAS) of pain and limitation of daily activities according to Oswestry Disability Index (ODI). The results of the year-long research, which demonstrated a considerable reduction of pain intensity in the monitored groups of patients after 6 months from the treatment and a considerable reduction in the group of patients who underwent epiduroscopy by the method of mechanical adhesiolysis with the administration of a medicine after 12 months from the treatment, were published in this year’s March issue of the prestigious scientific magazine Pain Medicine (Oxford Academic Journal).

From the course of epiduroscopic procedures at the Clinic of Mini-invasive and Endoscopic Back Treatment 

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