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Recommendations for Epiduroscopy

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Abstract

The following recommendations are based on our years of clinical experience with epiduroscopy:
  • To guarantee an efficient epiduroscopic procedure and ensure patient safety, the pain therapist performing the invasive intervention must be experienced in using the examination technique and have a well-founded theoretical background and a certain amount of manual dexterity.

  • The procedure requires an epiduroscope or epiduroscopic equipment that meets the requirements for epiduroscopy.

  • In addition to precise pain diagnostics and professional technical management, the success of an epiduroscopically assisted invasive pain management intervention depends on the selection of suitable patients.

  • Basic prerequisites for performing the invasive epiduroscopic procedure are a thorough clinical and functional examination and imaging diagnostics.

  • For quality assurance purposes, the basic information included in the informed consent discussion with the patient regarding epidural diagnostics and pain management must be documented.

  • Regardless of the hospital structure, epiduroscopy should be performed only on cooperative patients with adequate continuous monitoring of vital signs (anesthesiological stand-by) in a suitable operating room.

  • The anatomical architecture of the vertebral canal and the vulnerability of the spinal structures, especially in the cervical and thoracic segments, require epiduroscopy to be performed in a precise, standardized manner.

  • We recommend that prior to each epiduroscopy, epidurography be performed with contrast media either via the needle introduced with a sacral approach or via the introducer.

  • The use of a flexible, steerable epiduroscope requires a sacral approach to the epidural space.

  • The sacral approach technique calls for the patient to be placed in a prone position on the operating table.

  • Epiduroscopy should be performed under local anesthesia or analgosedation.

  • Once the sacral hiatus has been punctured, an aspiration test should be performed. If it is negative, a guidewire should be introduced into the sacral hiatus via the puncture needle over a short distance using the Seldinger technique.

  • Using a C-arm can be helpful for identifying the guidewire and locating the position and level of the epiduroscope in the vertebral canal.

  • The dilatator and sheath are advanced a short distance in the sacral canal via the introduced guidewire.

  • Continuous epidural irrigation with physiological saline solution at body temperature adapted as needed is absolutely mandatory for epiduroscopy. The aspects pressure-infusion volume limits, and if necessary, epidural pressure monitoring and drainage of the epidural irrigation fluid, must be taken into account.

  • The epiduroscope may only be navigated if good vision (saline irrigation) is ensured. Interventions should be carried out only if endoscopic vision is good.

  • For safety reasons, a laser should be on hand if coagulation is needed to stop bleeding.

  • Prior to the procedure, instruments to be introduced into the working channel of the endoscope must be checked to ensure they are in good operating condition.

  • The epiduroscopy must be recorded in a protocol. Endoscopic imaging should be documented on a video film, a memory stick, a CD-ROM or DVD.

  • With suitable epiduroscopic equipment, ensuring optimal vision and by gaining experience with the epiduroscopic technique, complications can be kept to a minimum.

  • Epiduroscopy is superior to imaging procedures, failed conservative treatment and open surgical techniques, especially with regard to the high rate of patient satisfaction and the remarkably low number of complications.

Keywords

Manual Dexterity Vertebral Canal Ensure Patient Safety Open Surgical Technique Epidural Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Copyright information

© Springer Medizin Verlag Heidelberg 2008

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