Epiduroscopy for patients with lumbosacral radicular pain.
Lumbosacral radicular pain is a pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major source of lumbosacral radicular pain is failed back surgery, which is defined as persistent or recurrent pain, mainly in the region of the lower back and legs even after technically, anatomically successful spine surgeries. If lumbosacral radicular neuropathic pain fails to respond to conservative or interventional treatments, epiduroscopy can be performed as part of a multidisciplinary approach. Epiduroscopy aids in identifying painful structures in the epidural space, establishing a diagnosis and administering therapy. The novelty consists in the use of an epiduroscope to deliver therapies such as adhesiolysis and targeted administration of epidural medications. Clinical trials report favorable treatment outcomes in 30% to 50% of patients. Complications are rare and related to the rate or volume of epidural fluid infusion or inadvertent dural puncture. In patients with lumbosacral radicular pain, especially after back surgery, epiduroscopy with adhesiolysis may be considered (evidence rating 2 B+).
Department of Anesthesiology and Pre-operative Screening and Pain Center, Rijnstate Hospital Velp, Velp, The Netherlands.
Jan Willem
JW
Kallewaard
Pascal
P
Vanelderen
Jonathan
J
Richardson
Jan
J
Van Zundert
James
J
Heavner
Gerbrand Jan
GJ
Groen
D000767:Anesthesia, Epidural / Q000379:methods*; D004824:Epidural Space / Q000187:drug effects / Q000502:physiology*; D019317:Evidence-Based Medicine; D005471:Fluoroscopy; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region
adhesiolysis; epiduroscopy; evidence-based medicine; low back pain; systematic review