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?
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.
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.
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
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?
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
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 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.
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.
Lateral view: Epidural needle inside
sacral canal and contrast injection
PA view: Illustration of insertion of stylet
PA view: Positioning of video catheter
towards L5 nerve root and adhesiolysis
PA view: Injection of contrast with filling of L5 nerve
root after adhesiolysis
PA view: Positioning of video catheter towards S1 nerve
root and adhesiolysis
PA view: Injection of contrast following
S1 nerve root adhesiolysis
Fluoroscopic illustration of placement of needle, contrast
injection, video catheter placement and adhesiolysis
anatomy of lumbar epidural space
of endoscopic anatomy and adhesiolysis of lumbar epidural