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The advanced endoscopic operation of Epiduroscopy is used in the treatment of chronic back pain, which resurfaces or continues after surgery on the spine as a result of the FBSS syndrome (failed back surgery syndrome). The cause or source of pain is fibrous adhesions, or epidural fibrosis, in the spinal canal, which up to 1/3 of patients form after operations. The fibrous adhesions irritate the spinal roots and may even cause a narrowing of the epidural space. During the epiduroscopy a special needle is introduced through the hiatus sacralis, a natural hole in the sacrum, and a working channel is formed through which other working instruments and an endoscope are introduced. Under direct visualisation and under the control of an x-ray, the fibrosis is then removed with a laser or a radiofrequency probe. If the epidural space is reduced, a balloon catheter is used to enlarge it and make access easier.
Benefits
The operation is performed at prone position and under local anaesthesia; it is painless and extremely easy on the patient. It takes place under continuous x-ray inspection and using direct visualisation with an endoscopic camera.
According to the ISMISS1, compared to conventional surgery it brings a number of benefits to the patient:
- lower risk of nerve damage,
- smaller formation of epidural fibrosis,
- faster recovery and a return to work,
- smaller incidence of infections,
- a smaller surgical incision and less surgical trauma
It is carried out as a one-day surgical technique (the patient returns home on the same day after surgery).
1ISMISS (International Society for Minimal Intervention in Spinal Surgery) according to the manual 'Guidelines for Endoscopic Spinal Surgery', approved by the ISMISS Committee 28. 1. 2010, www.ismiss.com