Spinal EndoscopySpinal Endoscopy is a procedure used to diagnose and treat the causes of chronic low back pain and radiculopathy. Using an instrument called a flexible fiber optic endoscope and Video Guided Catheter, the physician is able to visually inspect anatomical structures, tissues and nerves inside the epidural space. How does spinal endoscopy work? Often, the body in its natural attempt to heal from injury or surgery, will develop tissue which will encase nerve roots. These adhesions may cause irritation and inflammation, potentially resulting in severe and chronic pain. Adhesions are very difficult to visualize with the standard MRI or CT scans. During the initial clinical trials of the spinal endoscope, physicians discovered that many patients examined by MRI or CT scan often had adhesions that went undetected. Spinal endoscopy confirmed the presence of adhesive tissue in these same patients. Today, physicians often treat chronic low back pain and radiculopathy by injecting medication into the epidural space with a needle and syringe. Unfortunately, injected medication will frequently flow away from the encased and inflamed nerve roots. As a result, relief may be temporary or not at all. Spinal endoscopy is a relatively simple procedure that is performed in a hospital or surgical center on an outpatient basis. After receiving some mild sedation, the physician will inject a local anesthetic into the lower part of your back. The physician then introduces the Video Guided Catheter and flexible fiber optic endoscope into the epidural space. The catheter and endoscope are carefully advanced to the area of suspected pain. You may feel some pain as the instruments moves close to the inflamed nerve. In fact, the physician may replicate your pain and ask if this is the type of pain you usually feel. Using a combined technique of catheter movement and irrigation, the physician can separate many of the adhesions encasing the nerve roots. This allows the physician to directly see the inflamed nerve root, its texture, color and severity of inflammation. The physician can then place medication directly onto the irritated nerve root. After the procedure, you are sent to the recovery room for a short period of time, then released to go home. What are the side effects of spinal endoscopy? As with any invasive procedure, you may experience some side effects. Side effects may include: burning or tingling during the procedure, headache during and following the procedure, pain at the site of, insertion for a few days, and small amounts of drainage from the site of insertion. How do I know if I am eligible for spinal endoscopy? Spinal endoscopy is not for everyone and not everyone can benefit from the procedure. Your physician can determine your eligibility after performing a thorough history and physical examination. You are probably a candidate for spinal endoscopy if your back pain radiates to the legs (this is called radiculopathy) and you have failed other less invasive or conservative therapies or surgery. You are less likely to be a candidate if you have other serious diseases or psychiatric / psychological disorders. Are there special instructions I need to follow at home? WHAT TO EXPECT THE DAY OF SURGERY: Upon arrival to our Center the receptionist will register you and copy your insurance card. You will then be escorted to a room where our staff will complete a pre-assessment of your past and current health history. You will then speak to our staff anesthesiologist who will discuss the appropriate anesthesia protocol which will best suit your needs. After the pre-assessment, you will be escorted to the holding area where baseline vital signs will be recorded and an intravenous line will be started. After surgery is completed, your stay in recovery will be approximately 45 minutes. You will then be transported back to the pre-operative area, or discharged home. It is necessary to have a responsible adult to accompany you home. You will be given a post operative appointment
card prior to your discharge. If you wear acrylic nails, any
2 nails on the left hand must be removed before arriving at
the Surgery center.
Procedure – A tiny area is numbed at the base of your tailbone, away from where the injury is located. This prevents additional injury to the muscles, tissues, and bony structures surrounding the injury site. A needle is introduced to allow insertion of the catheter with the scope. The catheter is slowly advanced and your physician asks you to tell him when you feel the catheter touching the injured nerve. The amount of pain you will feel varies from patient to patient, and it can be reduced by pulling the catheter back if he gets too close to your injured nerve. Once he has located and identified the injured nerve, he injects medicine onto the injured nerve. This should reduce inflammation and may wash away the materials that are causing your pain. The entry site is then covered with a small bandage and after a short time in the recovery unit, you will be sent home.
 Normal endoscopic anatomy of lumbar epidural space
Typical findings of endoscopic anatomy and adhesiolysis of lumbar epidural space |
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