Epiduroscopy in the management of post-surgical epidural adhesions and chronic back pain

Manejo de adherencias epidurales y dolor lumbar crónico posquirúrgico con epiduroscopia

Primary objective: to describe epiduroscopy as a treatment modality for epidural adhesions and chronic pain in patients diagnosed with persistent post-lumbar surgery syndrome (PLSS) at Hospital de San José de Bogotá, during the 2013 to 2019 period. Secondary objectives: to describe epiduroscopy  as a safe procedure  carrying low hemorrhagic and neural injury risk, and to consider it an alternative. Background: in patients with PLSS, previously called failed back surgery syndrome, the decision to perform a new open surgery was strenuous; epiduroscopy (IESS, interventional  endoscopy spinal surgery) can improve symptoms avoiding open surgical reintervention,  as it is a minimally invasive diagnostic and therapeutic percutaneous procedure. Materials and methods: 8 patients from Hospital de San José database, who underwent  IESS for PLSS, between 2013 and 2019, were included. The Visual Analog Scale (VAS) was used in the valuation of population characteristics and complications. Results: 75% had VAS scores of less than 7.5 relative to an initial 10/10, the study showed improved clinical outcomes of more than 20%, with a median of 6 and a minimum value of 4; complications occurred in 44% of patients, as follows, headache responsive to conventional analgesia in 22%, radiculitis in11% and dural puncture in11%, which are lower than those documented in published literature. Conclusion: epiduroscopy is an innovative procedure in the management of PLSS. It is a minimally invasive technique used in the management of nonresponsive pain, therefore, patients in whom this management is indicated should be identified rapidly at the pain management clinic consultation.

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