[Epiduroscopic diagnosis and treatment of epidural adhesions in chronic back pain syndrome of patients with previous surgical treatment: first results of 31 interventions].
OBJECTIVE
Scars in the epidural space play an important role in the chronic lumbar pain syndrome of patients with previous surgical treatment. The results of surgical resection are frequently unsatisfactory. Discrepancies to imaging diagnostics are conspicuous. These are known from experience with endoscopic operations. Minimal adhesions may promote pain. Epiduroscopy is available for visualization of the epidural space. The objective of this study was to examine its possibilities in patients with previous surgical treatment.


METHODS
31 patients with chronic lumbar pain syndrome who had previously received surgical treatment were operated epiduroscopically. Mechanical instruments and the holmium:YAG laser were used for epidural adhesion.


RESULTS
All patients showed adhesions. 24 patients also presented with adhesions on the contralateral side. There were marked discrepancies between imaging and intraoperative findings. The use of mechanical instruments was limited. The use of laser fibers resulted in greater possibilities. Back pain could be better influenced than leg pain. The procedure was limited by still-existing technical problems.


CONCLUSIONS
Epiduroscopy offers a novel view of this compartment. Minimal adhesions which are not visible in imaging ean promote pain. They can be partially diagnosed and treated by epiduroscopy. There are still marked limitations to epiduroscopy due to technical problems. These must be minimized.
Ruetten
S
S
Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital, Herne, Germany. ruetten@orthopain.de
Meyer
O
O
Godolias
G
G
D000328:Adult; D004724:Endoscopy; D004824:Epidural Space / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053685:Laser Therapy; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D000267:Tissue Adhesions