How we can see and treat the epidural space: Epiduroscopy

Low back pain (LBP) syndromes represent a heterogeneous category of pathology, such as the failed back surgery syndrome (FBSS). LBP treatment includes conservative and interventional procedures, with high costs and low efficacy in most cases. Epiduroscopy has been revalued only recently for the treatment of LBP. The procedure was first performed using a percutaneous approach, which is still used with efficacy for LBP and/or radiculopathy. The classic epiduroscopy procedure, however, has a great limitation, because it uses only liquids to visualize the dura space, and it can not overcome fibrotic obstructions of the channel. Because of these limitations, we introduced a new epiduroscopy technique, which allows a direct visualization of the dura during the lysis, and reduces the risks related to the procedure. We performed a literature review of the percutaneous approach and compared it to our experience with Resaflex and Resascope for epidurolysis, in order to assess the therapeutic benefits of the two methods, and their role in the study of dura morphological components in FBSS. Percutaneous adhesiolysis and our endoscopic method showed similar efficacy level, however, the Resascope resulted in less complications and a better lysis. Since our endoscopic method proved to be safe and repeatable for the treatment of FBSS and the study of normal and pathological morphologies of the dura with direct imaging, we suggest using it as first choice in patients suffering from FBSS.