A Alexandre, A Alexandre
A Alexandre, A Alexandre. Spinal Endoscopic Lumbar Peridurolysis. Six years experience.. The Internet Journal of Minimally Invasive Spinal Technology. 2008 Volume 3 Number 4.
Endoscopic Lumbar Peridurolysis is a minimally invasive approach which was conceived for completing the diagnosis and improving the treatment of chronic low back pain and radiculopathy .Conceived by Barman in 1931, epiduroscopy was used on patients by Pool in 1937. He published in 1942 his experience on 400 patients. Results were poor because of the rigidity of the systems , and because of their calibre. Another point was the impossibility of registering images and obtain permanent documentation. New interest on epiduroscopy started in 80ies, when Blomberg utilized it for anatomical studies (published in 1989).Sabersky used epiduroscopy in clinical practice on 10 patients in 1989, simultaneously injecting cortisone by the caudal approach.After these experiences, it was only at the end of the Century that new refined, flexible fiberoptics and flexible and orientable guides allowed regular and safe clinical use.TECHNIQUEThe apparatus employes hjgh resolution optics and has a wide field of view. Operation is performed by a flexible fiberoptic scope which is 0.9 mm in diameter. Endoscopic Lumbar Peridurolysis may be performed both for diagnostic and for therapeutic proposals. Our series includes patients treated because of low back pain sine materia, and patients suffering because of post-discectomy syndrome. This endoscopic procedure will not provoque new scarring and will not expose the patient to the well known problems and risks of reoperations. The entire procedure can be performed under light anesthesia, and the patient will be discharged without danger the following day.PATIENTSWe have used this technique in a series of 2156 patients, affecte by low back pain and/or radicular pain withminor neurological deficits, after neuroradiological demonstration of :Spinal canal stenosis in 835 cases, Contained disc herniation in 318 cases, FBSS in 893 cases,Lumbalgo sine materia in110 cases.RESULTSThe observed results are1- Low back pain sine materia: at 6 months very good result in 80 %; good in 15 %; no result in 5 %2- Low back pain sine materia: at 12 months very good result in 66,7 %; good in 25 %; no result in 8,3 %.3- Post-discectomy syndrome: at 6 months very good result in 56.7%; good in 17.8%; insignificant in 11.1%; no result in 14.4%4- post-discectomy syndrome: at 12 months very good result in 48.9 %; good in 21.85 %; insignificant in 13.75%;no result in 15.5 %.