Caudascopic experiences and a new patho-anatomic concept for treatment of sciatica.
In order to investigate the potential of an exclusively endoscopic extradural approach as an alternative to open discectomy, epidural endoscopy was performed in 5 cadavers. This did not produce satisfactory images of the epidural space. Intradural endoscopy (caudascopy) was performed, to show whether additional anatomical factors might explain a radicular syndrome supplementary to or without a disc herniation. Caudascopy allowed excellent images of the cauda equina, nerve roots, and the entrance of the lumbar nerve root sheaths. A Fogerty balloon positioned in the intervertebral foramen was used to simulate disc herniation. The impact of this simulation on the intradural endoscopic image was observed to be minimal. A dural fold was identified at the entrance of the nerve root sheath. It is proposed as a factor contributing to the mechanical involvement of lumbosacral nerve roots. Pressure measurements in the intradural nerve root sheath support this preliminary finding. An endoscopical management of this potential patho-anatomy of the nerve root is suggested.
Beuls
E A
EA
Department of Neurosurgery, Academic Hospital Maastricht, The Netherlands.
van Mameren
H
H
Vroomen
P C
PC
D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012584:Sciatic Nerve / Q000503:physiopathology / Q000601:surgery*