Epiduroscopy?

[mmglobal]

LC in UK is talking about epiduroscopy. From BC's policy website:

Epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, is an endoscopic procedure in which the epidural space is explored for the purpose of diagnosing and treating spinal pain, specifically radicular pain. A steerable or controllable flexible endoscope is used to examine the epidural anatomic structures to find epidural adhesions, fibrosis and scars, and to provide precision directed therapy.

The may also be done in conjunction with RACZ or other procedures. There is a ton of info available online... much of it looks like sales info from pain clinics offering this procedure. Google Search results here

It will be interesting to see how the discussion goes... I'll see if I can get some of the docs to comment.

Mark

[LC in UK]

Yes, does sound like the procedure I'm having but never heard that terminology.
We get scant information on this to relay back but I'm known for asking questions so I'll see what else I can contribute to the discussion afterwards if it's any help.
Wish they'd thread this thing all the way to the top of my spine but doubt it very much!

[fireyangel76]

Do we do this in the US? Sounds like a good idea and may be a better diagnostic tool than anything I have ever had done. Of course the only thing ever offered to me was an MRI and with HMO's it was difficult to get that!

[mmglobal]

The literature I found on it was from the 1990's. I discussed this as a possiblity for me back in 2001... but that discussion was not with a surgeon. In all my travels with hundreds of clients and dozens of doctors, we've not talked about epiduroscopy. That does not mean that it's not a useful tool. I'm hoping to discover that in cases of unexplained nerve pain that they can go and potentially find places where there are tissues adhered to the nerves and free them up.

More later...

[Maria]

edited as necessary

[LC in UK]

Had spinal probe yesterday (epiduroscopy) and no opportunity to discuss this with any medics. Theatre lists were all at sixes and sevens for some reason. Procedure was followed by neck X-ray after I was returned to the ward and told to expect a follow-up appointment for 2 weeks time. This will arrive in the post!
This is what happened for the spinal probe......a very abrupt young registrar put the consent form on the anaethetic trolley for me to sign and was in no mood to discuss anything with me at all. Shameful.
Think the two anaesthetists were embarrassed at his attitude.
Fortunately my consultant did the procedure, he did give me a big smile when I was wheeled in to the theatre and I remember positioning myself on the bridge shaped support before my sedation was topped up.
All I recall was being asked about sensation and I know I replied "painful" twice.
So I'll have to wait a couple of weeks or so before I get to see the consultant again for the results of probe and X-ray.
Sorry I can't be more helpful than that!
Intend taking things easy today, bit sore from the procedure but hopefully the medication they've put in will ease whatever's going on in there!
Bye for now
Lynette

[mmglobal]

Lynette, I'm glad to hear that you are not complaining about increased pain levels from the procedure. Hopefully they will have learned something useful. Or, perhaps the painful sensations were when they were freeing adhesions that were tethered to the nerves. Maybe, you'll exerience some relief before you go for your consult.

What is the purpose of the consent form? Are you signing to indicate that you give your "informed consent?" We have some strange and broken systems in place!

Mark

[LC in UK]

Hi Mark
Yes, I think I did sign to give my "informed consent"....terrible system we have here. As for the outcome, all I heard when I came out of recovery was the ward Sister saying I had a "small bulge in the L3/4 area" and that doesn't account for the symptoms I have.
The numbness in my left leg from the probe anaesthetic has worn off now and I'm a bit sore where they inserted the probe but that doesn't worry me. I knew I'd have wobbly legs for a short while. But...still have problems with walking around, like I'm propelling myself from the hips, aching burning sensations on the outside of the hip joints and my legs feel heavy.
I'm really interested to see what comes of the neck x-ray, I know I really need the cervical MRI but it's a start. The spurs will show up anyway and surely if they see those they should investigate further ?
Lets hope I get the chance to talk to my consultant in a couple of weeks and see what he thinks, because nobody came to talk to me before the procedure or afterwards.
Be in touch, thanks for writing
Lynette

[fireyangel76]

Hi Lynette, I am glad you faired the procedure okay. Do you have any results yet?

[Maria]

Lynette,
Your symptoms sound much like mine were back in 2001 or so. I wondered if this was related to SI joint pain, disc bulging, scar tissue, maybe formation of newer pain generators in annular tissue, piraformis syndrome, combination of this that and everything~

Long story short, these symptoms have all but disappeared with use of Neurontin, lumbar ESIs (none since 2006) and low dose Methadone. Not that these symptoms cannot be recreated because with sitting a bit too long or too much, much what you've described plus low back pain returns and is very nasty but will go away again within a day or two (sometimes a week) if I don't sit much.

I hope the procedure will have helped you ~ I'm thankful that you've brought the topic to light and are sharing your information.

take good care ~ Maria

[LC in UK]

Thankyou Fireyangel and Maria for writing
I will have my follow-up with the consultant who carried out the epiduroscopy next Tuesday 7th August.
I don't think anything ominous was found in the lumbar region - probably scar tissue etc etc. But I will be asking about my neck X-rays which were taken a couple of hours afterwards. Something is causing these problems...leg and knee weakness and other things. I've had so much trouble with my upper spine but nobody's ever suggested it warranted further investigations. Just sent me for physio and suggested painkillers.
I've been putting up with this awful throbbing band of pain around my head too, whenever I get up from sitting plus if I flex my neck back too far I feel like I'll pass out.
Have you had similar symptoms?
I guess with me all the attentions gone on my lumbar spine and I didn't like to push my luck and ask for an MRI at the top!!
Oh well....next Tuesday will soon be here and once again my daughter's going with me, we make each other laugh a lot so it'll be another good day out!
Hope you're both bearing up well too.
By the way I don't take any painkillers apart from Paracetamol, realised quite a time ago that NSAIDS etc did my bowel and stomach no favours at all. Was put on the new one Arcoxia but the inside of my mouth became badly bruised and the pharmacist said to stop it immediately.
What side effects do you notice from your medications?
Oh and one last thing, started back at the gym again....the only way is up!!

[Maria]

Had really horrific spinal fluid leak headaches with myelograms and spinal tap so those were THE WORSE! Ugghh on headaches and hope you'll find some relief. I take Fioricet for the migraines and there is some muscle relaxation with this as well~ Perhaps what you may need (muscle relaxer that is)...

Stay well~

[LC in UK]

Haven't heard of Methadone or Neurontin being prescribed here in the UK but maybe it goes under a different name?
1800mg sounds a lot, but what do i know?! Wouldn't like to feel sluggish, that's the trouble when you need really strong painkillers, there's always a drawback, I know codeine slows the bowel down too.
I know about the myelogram headache as well..... had one in 1983, never felt so ill, was sick everytime I moved my eyes or turned my head. Apparently the dye gets to the top of the spinal cord and inflames the brain...so I was told. My laminectomy (1st one I ever had) was delayed by a week following the myelogram because it made me so ill. It left me with circles under my eyes!
When I was asked to have another one done in 1988 I refused, point blank. I travelled to London to have a private MRI done, cost £300 back then but it was worth it!
Am considering paying privately again to have a cervical MRI done if I'm not offered one on the NHS soon.
Well done with the walking, I'm not up to much of that lately but hopefully it's a temporary situation!
Best wishes
Lynette

[LC in UK]

Had follow-up to Spinal probe today and was told results of neck x-rays are "not good".
Am being referred to a neurologist straightaway as they think the problems I'm having with walking and other things is due to the spinal cord in the neck being compressed. I was shown the x-ray and apparently the vertebral column in my neck is straight and there should be a curve in it.
Also my reflexes were not good enough either so I hope I'm not left waiting too long......?
Here I go...............!!!!

[fireyangel76]

Lynette,
I am sorry your results were not good news. At least now you know the reason for your symptoms. That old saying "better the evil you know than the evil you don't.
Have you any pain in the neck? I don't think I ever recall you mentioning that?
Keep us posted on how you are going to proceed now knowing the condidtion of you cspine.
I hope you are not in any intolerable pain.

[LC in UK]

Hi Betsy
Thanks for your support! Have had years of neck arm upper spine probs. Got used to having pain up there but the last really bad pain episode was 2 years ago when my neck was pulled down to the left, shooting pains all the way down my arm and and the fingers of my left hand twitching involuntarily.....touch of the Frankenstein's monster I told you about!!!
Only ever given painkillers and physio. Have had numb arms and hands at night for years but the medics were'nt bothered about it when I told them so I presumed it wasn't significant.....now it seems to be "all systems go".
Hopefully they will be "running with this" and not lose it in the system somewhere! Now my Dad's poorly (80) and I'm taking him to hospital this morning, haven't time to fret about myself too much!! oh and my Grandaughter's into hospital this morning for her 2nd adenoids op....never rains but it pours! All will be well though.
Hope you're not faring too bad at the mo? Will catch up when things settle a little,
Love and stuff
Lynette

[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.