L Rothstein. Anterior Epidural Endoscopy: A New Approach. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.
Epiduroscopy remains a controversial technique in the management of low back pain. The nomenclature has caused confusion, and this paper uses Epidural Endoscopy to describe access through the sacral hiatus with the steerable catheter and fiberoptic endoscope. Despite debate over indications and outcome, the procedure has shown promise for diagnosis of epidural pathology and the delivery of medication to inflamed nerve roots. The traditional approach has been extensively described in the literature, which includes the assumption that the steerable catheter will be in the posterior epidural space. Similar to other epidural techniques, one of the limitations has been the inability to access the nerve roots, or more importantly, the source of the pathology. The expanding interest in intervertebral, or transforaminal techniques, supports the rationale of targeting pathology in the anterior epidural space, which is typically where it originates. This paper describes a new approach for Epidural Endoscopy to access the anterior epidural space. Extensive experience with the technique, and a large case volume with no complications that can be attributed to the approach, demonstrates that this approach is safe, and may further advance the treatment of low back pain.