Epiduroscopy was developed in the 1990's. A fibre optic
camera is inserted through the sacral hiatus into the
lower epidural space, and is then guided upwards towards
the lower lumbar discs and nerve roots.
Epiduroscopy has two main uses in the pain clinic:-
Releasing epidural adhesions
for the relief of chronic sciatica. Adhesions can form
around the lower lumbar nerve roots after decompressive
surgery for disc disease, or after a bad bout of
inflammatory sciatica in the absence of surgery.
Epidural adhesions can usually be identified on an
enhanced MRI scan using intravenous gadolinium. They
also cause uneven spread of X-ray contrast when
performing an epidurogram.
mixtures of local anaesthetic and depot steroid around
inflamed nerve roots when epidural injections / nerve
root blocks have been unsuccessful. The presence of
adhesions can prevent epidurally injected drugs from
reaching the inflamed nerve roots.
Epiduroscopy is not advised in the presence of altered
coagulation (warfarin, liver or haematological disease).
• The elderly do not tolerate the procedure well due to
the rise in intra-cerebral pressure caused by the saline
procedure is performed in the face-down position, under
intravenous sedation and local anaesthesia, whilst using
X-ray screening in an operating theatre to minimise
• Local anaesthetic is injected in and around the sacral
hiatus to numb the area. A small needle is inserted
through the sacral (caudal) hiatus into the epidural
space. Through this needle is then passed a fine metal
guide wire. The small needle is then removed leaving the
guide wire in place in the epidural space. A series of
dilators are then passed over the guide wire until the
sacral membrane will accept a sheath cannula (see
diagram above). Once the sheath is in place, the guide
wire is removed.
• A steerable catheter attached to a fibreoptic
epiduroscope is then inserted through the centre of the
sheath until it enters the epidural space. Passage of
the steerable catheter is enhanced by using a saline
flush system attached to a side port on the sheath.
• The fibreoptic epiduroscope is then advanced upwards
using X-ray guidance, until it reaches the area where
Epidural Adhesions have been found on an MRI scan.
• Once in the correct area, epidural adhesions can be
gently broken down using the Epiduroscope Tip.
Afterwards, local anaesthetic and depot steroid can be
injected around any inflamed nerve roots in the area.