Spinal endoscopy

Posted June, 2008

Spinal Endoscopy (SE) is a procedure Dr. Robb uses to diagnose the causes of chronic low back pain, and once he's properly revealed them, he'll work to remedy them. This page will explain the basics of how SE works and what it can do for a patient with low back pain. It answers most basic questions about the procedure.

How does Spinal Endoscopy work?

Dr. Robb uses an instrument that's called a flexible fiber optic endoscope. This instrument is essentially a small pliable hose filled with optical fibers, a small very bright light source at the insertion end, and a camera that feeds a video signal to a televison monitor. Using this tool, Dr. Robb is able to visually inspect the tissues and nerves inside the epidural space of your back. (This is the region that's located within the spinal canal, on or outside the dura matter, the tough membrane that surrounds the spinal cord.)

The human body—in its normal attempt to heal from injury or surgery—can develop tissue that encases nerve roots. (The root is where the nerve comes out of the spinal cord in order to connect to other body parts). This encasing tissue can irritate the nerves, creating inflammation. The inflammation can cause severe, chronic pain. When this happens in the low back (or lumbar spine) the patient experiences a classic case of chronic "lower back pain."

The adhesions (when one type of tissue sticks inappropriately to another part of the body) are very difficult to see using standard non-invasive methods such as MRI or CT scans. In fact, during the medical trials of the endoscope, doctors discovered that several patients previously examined by MRI or CT scans had previously undetected (and painful) adhesions. Overall, the endoscopic procedure is superior to other means for finding (and then helping to remedy) these painful changes to the structures of the spinal tissue and subsequent irritation of the nerve roots.

Physicians often treat chronic low back pain and radiculopathy (this means there's a disturbance or pathologic change in one or more nerve roots which may cause radiating pain into another area of the body) by injecting medications into the epidural space with a needle and syringe. This method can certainly help many patients, and it's a good first step. But the injected medication sometimes flows away from the incased and inflamed nerves. Because of this, the relief these injections provide may be temporary or insufficient to solve the patient's pain.

SE is a reasonably simple procedure that Dr. Robb performs on his patient during an outpatient visit. He gently sedates the patient, and then injects a local anesthetic into the patient's lower back. He'll then introduce the special steerable catheter and fiber optic endoscope into the epidural space. He carefully advances the endoscope to the area that appears to be causing the patient's pain.

In order to best determine which nerves are causing pain, Dr. Robb may attempt to replicate your pain and ask you if what he's doing "feels" like the back pain you usually experience from the activities that trigger it. By moving the catheter and irrigating the epidural region (which means cleaning it with a special solution) Dr. Robb can seperate the adhesions that are encasing the affected nerve roots.

This allows Dr. Robb to see the inflamed nerve roots with the endoscopic camera. By examining texture, color, and how badly the nerve is inflamed, he can determine where to best place the anti-inflammatory medication. He'll then place this solution directly onto the irritated nerve root in order to provide maximum relief from pain.

After a brief rest in the recovery room, the patient can go home with only a small bandage on the endoscopic insertion site.

Are there any potential side-effects?

Of course with all medical procedures, there's the chance of some side effects. These vary from patient to patient, but may include some burning or tingling during the procedure, a headache during and following the procedure, pain at the site of the small insertion point for a few days, and there may also be small amounts of fluid drainage from the endoscopic insertion point. Overall, it's a very safe procedure with a high degree of success.

Who can have this procedure?

This procedure isn't for all patients, and not everyone will benefit from it. Only after Dr. Robb carefully examines you and your medical history can he determine if this is right for your pain issue. However you may be an eligible candidate if your back pain radiates to your legs, or if you've failed other, less invasive or conservative therapies or surgeries. You're less likely to be an acceptable candidate for SE if you've got other serious diseases, or psychological disorders.

Over all, however, for those patients whose lower back pain is likely to be caused by adhesions, SE can improve the quality of their lives and relieve chronic low back pain.