[paindoc]

Mark, a vast majority of pain docs are probably NOT advertising this as a procedure they do for the masses, not too many have trained to do them, and....insurance simply does not pay for it in most cases unless you use it in conjunction with a RACZ catheter....not worth it for most interventionalists. I did many in fellowship as I trained under Racz, and when I was doing them, the scopes were so poor that I could never understand the value, and actually had serious reservations about doing them regarding patient safety. However, the scopes have dramatically improved, and there is more a diagnostic value to them than a therapeutic value. Interventionalists live off the poor results of surgeons and one of the reasons that they create so many problems is that by compromising the epidural space surgically forms very tenacious scarring that can cause stenosis and teather nerve roots. You can really see this with the scopes. Also, if you want to get aggressive, you can try to reduce some bands of scarring with the scope. I now do them only on select patients that RESPONSIBLE surgeons send me to evaluate....rather than doing another surgery to create more scarring. I usually do them in conjunction with RACZ catheters and a remarkable number of patients improve.