in PDF format

LectureLumbosacral Spinal Canal Endoscopy – Lessons LearnedObjectivesUpon completion of this presentation attendees will be able to discuss• How epiduroscopy has furthered our understanding of pathophysiological processes associatedwith the development and maintenance of low back pain (LBP) and radiating pain (RP)• How epiduroscopy has contributed to improved diagnosis of sources of low back pain (LBP)and radiating pain (RP), especially common low back pain, and the treatment as well asprediction of treatment outcomes• How epiduroscopy has contributed to improved safety of interventional procedures on thespine• How epiduroscopy has helped expand knowledge of spinal canal anatomy• New treatment options emerging as a result of epiduroscopy• Future direction of epiduroscopyKey Points• Epiduroscopy provides information that aids in establishing a diagnosis and prognosis, locatingareas of pathology, and providing therapy via a minimally invasive approach in patients withlow back pain and/or radiating pain.• Epiduroscopy reveals pathological changes not reported from imaging studies such as CT scansand MRI.• Future direction of epiduroscopy includes advances in equipment technology, greater use as atool for diagnosis and prognosis, and new or improved therapies administered with the aid ofepiduroscopy.• Anatomic detail more fully disclosed by epiduroscopy, eg about the peridural membrane, is abasis for exploring new approaches for treating common low back pain• Knowledge gained by performing epiduroscopy, such as degrees of epidural fibrosis and vascularvariations, has contributed to improved safety and utilization of interventional procedures• Treatment outcomes are highly predictable when spinal canal endoscopy findings are used topredict outcomeReferences1. Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery:An endoscopic study. Spine. In press. Pain Practice 5/09.2. Heavner JE, Wyatt DE, Bosscher HA. Lumbosacral epiduroscopy complicated byintravascular injection: a report of two cases. Anesthesiology. 107:347-350, 2007.3. Racz GB, Heavner JE, Bosscher HA, Helms.The MILD Procedure. Consultant’s Corner.Primum non nocere. Pain Practice. Early View Online 3/26/134. Bosscher HA, Heavner JE. Lumbosacral epiduroscopy finding predict treatment outcomes.Pain Practice. In press 29Jul135. Bosscher HA, Heavner JE. Diagnosis of the vertebral level from which low back or leg painoriginates. A comparison of clinical evaluation, MRI and epiduroscopy. Pain Practice. 12:506-512, 2012.Hemmo Bosscher, MD, FIPPBiographical SketchDr. Hemmo Bosscher did his pain management fellowship with Dr. Racz at Texas Tech UniversityHealth Sciences in Lubbock, Texas in 2000. Dr. Bosscher has been in private practice in Lubbocksince then. He has been actively involved with the FIPP. His research interest is epiduroscopy and itsclinical utility. Several research papers, written with Dr. Heavner, have been published on this topic.– 19–