Background and Objectives. The lumbar epidural spaces of 12 patients with various pain syndromes were investigated endoscopically using a percutaneously inserted flexible catheter-secured epiduroscopic unit.

Methods. The instrument used in this pilot study consisted of an ultralow bore quartz fiberscope (0.8 mm O.D.), a video attachment, and a catheter protection-flushing system. Local anesthesia (mepivacaine hydrochloride 1%), was used to faciliate the painless percutaneous placement of the flexible epidural space.

Results. Epidural structures such as the ligamentum flavum, spinal dura mater, connective and adipose tissue, and veins and arteries were readily identified with the epiduroscope, and only minimal epidural hemorrhages were observed. Pronounced adhesions and fibrosis, along with puncture injuries of the ligamentum flavum and dura mater, were easily visualized and identified with the epiduroscope in two pain patients with failed back surgery syndrome. Epidural catheters were safely implanted in three patients under epiduroscopic control.

Conclusions. The epiduroscopic examination technique using a flexible catheter-secured epiduroscopic unit proved to be a virtually painless, safe, and practical method for the direct visualization of anatomy within the epidural space.