27th November 2006 at 14:15 GMT by Dr C.A.Jenner MB BS, FRCA. Permalink.
Article on the role of Epiduroscopy in the management of back pain
Epiduroscopy is a relatively new procedure developed in the 1990’s and is a must less invasive procedure than traditional surgeries performed on the lower back. Not only has this procedure been successful in helping to relieve some instances of chronic sciatica, it has also proven to be effective in cases where traditional epidurals and nerve root blocks have failed.
Sciatica is the term for pain down the leg that is caused by the irritation of the sciatic nerve, which is the largest nerve that carries messages back and forth to the brain. The source of the pain is usually where the root of the nerve passes through the lumbar vertebrae. Sciatica is very often caused by the degeneration of the intervertebral disc, or the cushion between the vertebrae that aid with movement and works as a shock absorber, causing the vertebrae to come closer together and putting pressure on the sciatic nerve. Adhesions can form around the nerve roots after decompressive surgery has been performed and even in cases when the area has been very inflamed after a bad bout of sciatica. This is when epiduroscopy can be helpful.
Just as the sciatic nerve can become irritated or inflamed and cause pain down the leg, other nerves that pass through the vertebrae to destinations throughout the body must pass through the delicate network of bones and joints of the spine and are vulnerable to irritation and pressure. Not only can a nerve root block help reduce the pain, but anti-inflammatory medication, such as steroids, injected at the nerve root can fight the inflammation and may even stop the pain from returning. However, when adhesions are present at the location of the nerve root, they can stop the solution from reaching the nerve root and the pain will not be relieved. In this case, an epiduroscopy can be effective.
An epiduroscopy is typically performed as a day procedure and the patient is usually awake and can communicate with the doctor. After light sedation and a local anaesthetic are administered, a very small incision is made and a fibre optic camera is inserted in the lower back and guided up towards the affected nerve roots. Thanks to the small camera and miniscule tools, the adhesions can be cut away and injections of local anaesthetic and steroid solutions can be made.
After the procedure, patients will rest in the recovery room and be monitored by medical staff. Most patients will be able to go home the same day, but should have someone available that can escort them home and stay with them for the remainder of the day. Some patients may feel immediate relief, while other may have to wait a few weeks, but the long lasting effects of the procedure can last for many months.
‘Epiduroscopy’ was posted by Dr C.A.Jenner MB BS, FRCA on 27th November 2006 at 14:15 GMT and filed under minimally invasive pain management.
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