Epiduroscopy

After a surgery in the lumbar region, pain in the lower back and legs may occur as a result of the healing tissue surrounding and compressing the nerves in the lumbar region. The purpose of epiduroscopy is to open the nerves in this area and separate them from the surrounding healing tissue (scar) in order to relieve these pains that do not respond to physical therapy methods. This procedure is called epidural lysis of adhesions, epidural lysis of adhesions, epidural neuroplasty or epidural adhesiolysis.

For this purpose, the epidural space around the spinal cord is entered percutaneously (through a needle channel) through the skin. The catheter can be inserted through the hiatus, the opening at the lower end of the sacrum, or through the foramen or interlaminar space where the spinal nerves exit. This procedure is performed under local anesthesia. With the fiberoptic endoscopy camera on the catheter tip, the lesion is seen and the catheter is moved and these tissue adhesions are tried to be opened mechanically (mechanically). At the same time, some drugs are injected into the epidural space or even directly above the nerve root to try to open these adhesions (chemical). In the same way, radiofrequency can be applied instead of injection (radiofrequency). Another method for opening adhesions during epiduroscopy is the use of a laser (laser). Analgesic treatments during this procedure help patients to relieve pain quickly.

Effectiveness

Although the results of worldwide studies are generally positive, mixed results have been reported. Opening the adhesions with epiduroscopy may be effective in relieving pain for a certain period of time if done with epidural injections, and if done multiple times, such as 4-6 times in a certain period. Similar results have been seen in patients using radiofrequency.

Side effects

Side effects of epiduroscopy are generally reported to be rare. Bleeding, infection, nerve damage, cerebrospinal fluid leakage and headache are common complications. It has been reported that side effects such as spinal cord compression, loss of vision, retinal hemorrhage, loss of strength due to heat damage to nerve roots due to laser use, allergic reactions, infection and meningitis may occur. These effects are all described for interventions performed in the lumbar region. Complications are more common when epiduroscopy is applied to the cervical spine for cervical hernia or narrow canal. In conclusion, although there are reports of patients benefiting from the treatment, its efficacy is still controversial.