Periduroscopy: general review of clinical features and development of operative models.
BACKGROUND
Myeloscopy is a useful approach for both diagnosis and treatment of back pain. However clinicians have underestimated its potential. From the nineties myeloscopy has been used only as a diagnostic tool, without any improvement of the technique. Racz's method is nowadays still used for the lysis of adherence by applying medical solutions without a direct vision inside the spinal channel. In 1998 we showed the limitations of Racz's approach, and in 1999 we developed a new technique, introducing a Fogarty balloon to remove the occlusions of the spinal canal and the resaflex for the lysis of adherence at low temperature (Raffaeli-Righetti technique). In this paper we report a general review of our experience with periduroscopy for the treatment of failed back surgery syndrome (FBSS) and spinal stenosis.


METHODS
A Fogarty balloon was used to remove fat and/or mild fibrosis occluding the spinal canal, reducing by 50% the volume of the saline solution used in periduroscopy. The Resaflex was subsequently used to lyse adherence and to allow reaching the site of pain origin, using a low temperature (> 50°C).


RESULTS
the fibrosis morphologies of epidural space (ES) were grouped on the basis of common macroscopic and organizational characteristics, which were revealed during myeloscopy. A year after myeloscopy, 59% of FBSS patients, and 67% of patients with stenosis reported a general improvement of their painful pathology, with a pain reduction above 50 in 56% of patients. Forty-eight percent of patients used minor analgesics and 67% of patients went back to work. Only few complications were observed (4%).


CONCLUSIONS
myeloscopy technique enlightens pain-triggering mechanisms otherwise unrevealed; it has specific therapeutic value, whereas on the diagnostic side it has not revealed relevant pathologies. Its effectiveness in FBSS patients is high, with the advantage of its relatively easy implementation, limited invasiveness and repeatability.
Pain Therapy and Palliative Care Unit, Infermi Hospital Rimini, 47900, Rimini, Italy. wraffaeli@auslrn.net
W
W
Raffaeli
D
D
Righetti
J
J
Andruccioli
D
D
Sarti
D000700:Analgesics / Q000627:therapeutic use; D004724:Endoscopy / Q000379:methods*; D004824:Epidural Space / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D055111:Failed Back Surgery Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D016037:Single-Blind Method; D013115:Spinal Canal / Q000187:drug effects / Q000601:surgery; D013130:Spinal Stenosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods
D000700:Analgesics