Dr. Gabor Racz in 1989, described a technique for lysis of epidural adhesions to treat lumbosacral radicular and/or low back pain. Since then, it has been used worldwide.
The technique is minimally invasive and relatively easy to perform.
Failed back surgery syndrome
Epidural adhesions, epidural fibrosis
Vertebral body compression fracture
Resistant multilevel degenerative arthritis
Pain unresponsive to spinal cord stimulation and spinal opioids
Local infection at the side of the procedure
Cauda equina syndrome
Obstruction of the sacral canal
Spinal dysraphism affecting area
Inability to maintain position
The technique involves
Performing an epidurogram to identify filling defects indicative of epidural scarring
Advancing a catheter in the anterolateral epidural space into the adhesions
Injecting hyaluronidase to facilitate adhesiolysis and normal saline to hydraulically separate adhesions and wash out epidural proinflammatory cytokines
Injecting anti–inflammatory and analgesic drugs and hypertonic saline to treat pain, inflammation and edema
Conclusion 1 Percutaneous epidural neuroplasty with the racz catheter is effective for pain reduction and functional improvement in patients with chronic low back and lower extremity pain refractory to conservative treatment and decreases the need for surgical treatment.
is the visualization of the spinal canal using a flexible fiber optic light source and endoscope.
epiduraloscopy or epiduroscopy
Definition: ‘Epiduroscopy is a percutaneous minimally invasive endoscopic examination of the epidural space that can also be used for therapeutic inventions’.
Spinal pain syndromes do not disappear by simply ignoring them.
Epiduroscopy offers a technique for diagnosing and treating spinal pain syndromes.
This may involve distinguishing pathological and anatomical structures and circumstances, such as epidural fibrosis following invasive procedures and radiculopathies
performing biopsies and smears,
removing irrigation fluid,
as well as performing an epidural pain provocation test (EPPT).
Direct application of pharmacologic therapy
Lysis of scar tissue
Catheter placement (epidural, intrathecal)
Implantation of stimulation electrodes (radio frequency therapy, spinal cord stimulation) under direct vision
Support during minimally invasive surgical procedures is another therapeutic indication for epiduroscopy.
Therapy with anticoagulants
Infections in the area of the puncture site
Special neurological disorders – High risk of cardiovascular disease – Patient’s refusal to undergo the procedure
Conclusion 2 Epiduroscopy is one of the best diagnostic and therapeutic tools for difficult spinal pain syndromes with wider uses in the coming days.
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