Abstract
ObjectivesEpiduroscopy is a minimally invasive procedure that is used in pain therapy to treat lumbar and root pain that is resistant to medical and infiltrative therapies. The indications for periduroscopy are partly shared with those of spinal cord stimulation (SCS): failed back surgery syndrome (FBSS) and stenosis of the vertebral canal in particular. The costs and risks of periduroscopy are considerably lower than those of SCS. The purpose of this study is to evaluate the clinical and economic advantages of integrating periduroscopy as a step prior to SCS for patients with severe lumbar or radicular pain that is unresponsive to pharmacological and infiltrative treatments.Materials and MethodsPatients were enrolled if they had FBSS and spinal stenosis with indications for SCS and accepted periduroscopy treatment before the possible SCS trial. Patients were followed up for 24 months with evaluations of clinical data on the day after the procedure and at one and 24 months. The pain trend, satisfaction with the periduroscopy procedure, and the incidence of SCS implants in the study period were analyzed.ResultsA total of 106 patients were enrolled. Immediately after the procedure and in the first month, the reduction of pain and the level of patient satisfaction were high, but they were drastically reduced at 24 months with a progressive reappearance of symptoms that substantially overlapped with the pre-surgery levels. At 24 months, 48% of the patients underwent a neurostimulation trial, and a significant percentage of them were able to avoid the implantation of an SCS.ConclusionsPeriduroscopy appears to be rational as a step prior to SCS in terms of the improvement of pain symptoms in the short term, the definitive results in a significant percentage of patients, and the significant economic savings for the health system.
Highlights
The story of epiduroscopy is one of intuition [1]
Patients were enrolled if they had failed back surgery syndrome (FBSS) and spinal stenosis with indications for spinal cord stimulation (SCS) and accepted periduroscopy treatment before the possible SCS trial
After the procedure and in the first month, the reduction of pain and the level of patient satisfaction were high, but they were drastically reduced at 24 months with a progressive reappearance of symptoms that substantially overlapped with the pre-surgery levels
Summary
The story of epiduroscopy is one of intuition [1] It is the same kind of intuition that is shared with the great seafarers who profoundly changed our way of thinking about the world in the XV century and moved the borders of the known universe a bit forward. In this case, the "New World" is the features of the tiny space known as the epidural space. The "New World" is the features of the tiny space known as the epidural space This anatomical space has been well known over the centuries, so the attribute “new” is not suitable. By the end of 1980 has it been primarily
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