Abstract
Background: Myeloscopy is a useful approach for both diagnosis and treatment of back pain. However clinicians have underestimated its potential. From the nineties myeloscopy has been used only as a diagnostic tool, without any improvement of the technique. Racz’s method is nowadays still used for the lysis of adherence by applying medical solutions without a direct vision inside the spinal channel. In 1998 we showed the limitations of Racz’s approach, and in 1999 we developed a new technique, introducing a Fogarty balloon to remove the occlusions of the spinal canal and the resaflex for the lysis of adherence at low temperature (Raffaeli–Righetti technique). In this paper we report a general review of our experience with periduroscopy for the treatment of failed back surgery syndrome (FBSS) and spinal stenosis.
Method: A Fogarty balloon was used to remove fat and/or mild fibrosis occluding the spinal canal, reducing by 50% the volume of the saline solution used in periduroscopy. The Resaflex was subsequently used to lyse adherence and to allow reaching the site of pain origin, using a low temperature (> 50°C).
Findings: the fibrosis morphologies of epidural space (ES) were grouped on the basis of common macroscopic and organizational characteristics, which were revealed during myeloscopy. A year after myeloscopy, 59% of FBSS patients, and 67% of patients with stenosis reported a general improvement of their painful pathology, with a pain reduction above 50 in 56% of patients. Forty-eight percent of patients used minor analgesics and 67% of patients went back to work. Only few complications were observed (4%).
Conclusions: myeloscopy technique enlightens pain-triggering mechanisms otherwise unrevealed; it has specific therapeutic value, whereas on the diagnostic side it has not revealed relevant pathologies. Its effectiveness in FBSS patients is high, with the advantage of its relatively easy implementation, limited invasiveness and repeatability.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bloomberg R. (1984) A method for epiduroscopy and spinaloscopy. Acta Anesthesiol Scand; 29: 113–116.
Bloomberg R. (1994) Epiduroscopy and spinaloscopy: endoscopic studies of lumbar spaces. Acta Neurochir Suppl; 61: 106–107.
de Tribolet N, Porchet F, Lutz TW, Gratzl O, Brotchi J, van Alphen HA, van Acker RE, Benini A, Strommer KN, Bernays RL, Goffin J, Beuls EA, Ross JS. (1998) Clinical assessment of a novel antiadhesion barrier gel: prospective, randomized, multicenter, clinical trial of ADCON-L to inhibit postoperative peridural fibrosis and related symptoms after lumbar discectomy. Am J Orthop; 27 (2): 111–120.
Fager CA. (1991) Role of laminectomy in lumbar disk herniation. Mt Sinai J Med; 58: 133–138.
Igarashi T, Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H, Suzuki H. (2000) The fiberscopic findings of the epidural space in pregnant women. Anesthesiology; 92: 1631–1636.
Manchikanti L, et al. (2001) Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial. Pain Physician; 4 (2): 153–166.
North RB. (1994) Spinal cord stimulation versus reoperation for the failed back surgery syndrome. A prospective, randomized study design. Stereotact Funct Neurosurg; 62 (1–4): 267–272.
North RB, Ewend MG, Lawton MT, Kidd DH, Piantadosi S. (1991) Failed back surgery syndrome: 5-years follow up after spinal cord stimulator implantation. Neurosurgery; 28: 692–699.
North RB, Kidd DH, Campbell JN, Long DM. (1991) Dorsal root gangliectomy for failed back surgery syndrome: a 5 years follow up study. J Neurosurg; 74: 236–242.
Ooi Y, Sathoh Y, Inoue K, Miganagi K, Morisaki N. (1981) Myeloscopy with special reference to blood flow changes in the cauda equina during Lasegue’s test. Int Orthop; 4: 307–311.
Racz GB, Havner JE, Singleton W, Carline M. (1988) Hypertonic saline and corticosteroid injected epidurally for pain control. In Racz GB (ed): Technique of Neurolysis. Boston, Kluwer Accademic. 73–86.
Raffaeli W. (1998) Periduroscopy: preliminary reports – technical notes. Pain Clinic; 11: 1–5.
Raffaeli W. (2003) Periduroscopia nel dolore lombare: dalla diagosi alla terapia. Reumatismo; 55 (3): 56–60.
Raffaeli W. (2006) Endoscopia dello spazio epidurale. Periduroscopia. In: Jankovic D, Borghi B, Rainaldi MP (eds): Anestesia regionale. Masson. 399–403.
Raffaeli W, Marconi G, Fanelli G, Taddei S, Borghi GB, Casati A. (2006) Opioid-related side-effects after intrathecal morphine: a prospective, randomized, double-blind dose-response study. Eur J Anaesthesiol; 23: 605–610.
Raffaeli W, Righetti D. (1997) The role of myeloscopy in diagnosis and therapy. In Neumann N, Barolat G (eds): IV INS World Congress, Abstracts, Geneva. 53–55.
Raffaeli W, Righetti D. (2005) Surgical radio-frequency epiduroscopy technique (R-ResAblator) and FBSS treatment: preliminary evaluations. Acta Neurochir Suppl; 92: 121–125.
Raffaeli W, Righetti D, Caminiti A, Ingardia A, Balestri M, Pambianco L, Fanelli G, Facondini F, Pantazopoulos P. (2008) Implantable intrathecal pumps for the treatment of noncancer chronic pain in elderly population: drug dose and clinical efficacy. Neuromodulation; 11 (1): 33–39.
Ross JS, Robertson JT, Frederickson RCA, Petrie JL. (1996) Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery; 38: 855–863.
Saberski LR, Kitahata LM. (1995) Direct visualization of the lumbosacral epidural space through sacral hiatus. Anesth Analg; 80: 839–840.
Saberski LR, Kitahata LM. (1996) Review of the clinical basis and protocol for epidural endoscopy. Conn Med; 60 (2): 71–73.
Schutze G, Kurtze H. (1995) Direct Observation of the epidural space with a flexible catheter secured epiduroscopic unit. Reg Anesth; 19: 85–89.
Shah R, Heavner JE. (2003) Recognition of the subarachnoid and subdural compartments during epiduroscopy: two case. Pain Pract; 3 (4): 321–325.
Conflict of interest statementWe declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this chapter
Cite this chapter
Raffaeli, W., Righetti, D., Andruccioli, J., Sarti, D. (2011). Periduroscopy: General Review of Clinical Features and Development of Operative Models. In: Alexandre, A., Masini, M., Menchetti, P. (eds) Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. Acta Neurochirurgica Supplementum, vol 108. Springer, Vienna. https://doi.org/10.1007/978-3-211-99370-5_10
Download citation
DOI: https://doi.org/10.1007/978-3-211-99370-5_10
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-99369-9
Online ISBN: 978-3-211-99370-5
eBook Packages: MedicineMedicine (R0)