Epiduroscopy in spinal stenosis. Description of the procedure and safety measures to reduce complications

The aim of this observational study is to describe the use of epiduroscopy to decrease the enlargement of the ligamentum flavum (LF) in patients with spinal stenosis, as well as the selection of the appropriate patient and the safety measures that enhance procedural success. We introduce the patient selection protocol, define the appropriate indication and the safety measures to use the epiduroscopy as a tool to decrease the size of the LF and increase space, reducing possible complications. Among patients included in the study, there were no cases of access difficulty or coccydynia, and one case of urinary incontinence occurred in a patient with Schizas grade D (very severe) stenosis. In patients with grade C or lower stenosis, we have not found any case of sphincter incontinence.In four patients, we found paresthesias and in one patient a transient increase in pain. Dural puncture was performed in three patients, none developed headache. Exclusion of patients with very severe canal stenosis according to magnetic resonance imaging (MRI) criteria, the use of sacral hiatus measurements and the neurophysiological monitoring helps diminish the occurrence of neurological complications of epiduroscopy in patients with spinal stenosis. https://www.clinicaltrials.gov identifier is NCT03863067.