Epiduroscopy - Causes, symptoms and treatment. MF.
Epiduroscopy is a three-dimensional color map of the anatomical structure of epidural space structures. This minimally invasive examination is carried out using a tiny hose with a chamber at the end that does not cause any damage and can examine the nerve fiber envelope, blood vessels, ligaments, adipose tissue, intervertebral discs, nerve roots, dura mater, can detect cicatricial changes, inflammation, infringement, damage, swelling, can establish a catheter and inject a drug.
Epidurocopy is used as a diagnostic and therapeutic procedure.
Advantages of epiduroskopii - safe access, epidural diagnosis, minimal anesthesia, accurate placement of catheters or electrodes, bypassing anatomical obstacles, removal of scar tissue, acceleration of the implantation process, digital documentation.
Indication of epiduroscopy
Indications for diagnosis - pain in the spine of unknown origin, postoperative pain. It is possible to take a biopsy.
With epiduroskopii it is possible to remove postoperative scars and adhesions, placement of catheterization systems, targeted administration of medicines, implantation of SCS( Spinal Cord Stimulation) - electrodes( neuromodulation).Electrostimulation of the spinal cord is indicated in severe pain syndrome with phantom pains, peripheral causalgia and neuropathies, spinal arachnoiditis. .. as a kind of "replacement" of the antinociceptive system.
SCS is a device - a source of pulses, epidural electrodes and conductors. Targeted administration of drugs( narcotic analgesics, steroidal anti-inflammatory drugs) inhibits pain impulses along nerve C-fibers. Catheterization provides palliative long-term neurochemical therapy for tumor processes.
Contraindications -
contraindications for local anesthesia( cutaneous infectious lesions at the incision site), hemorrhagic diathesis, anticoagulant treatment, high cardiovascular risk, exacerbation of intractable diseases( flu-like conditions, OPVI).
Preparing for epiduroscopy
Before the test( except for a general blood test, blood sugar, blood group and thorough clinical and functional examination - spondylography, computer and( or) magnetic resonance imaging), a blood test is necessary - a coagulogram. If the patient is taking blood thinners, the doctor should be informed.
Carrying out epiduroscopy
A study is conducted in the operating room under sterile conditions by a specially trained specialist.
Anesthesia is local with simultaneous intravenous administration of a hypnotic. The dose of anesthesia is small and the examination can be carried out in those cases when the general anesthesia is contraindicated( a serious condition, elderly age. ..).
In the patient's position, a small incision is made on the back in the area of the sacral aperture, and an endoscope is inserted into the epidural space. The patient may feel mild pressure. Under the complete control of the X-ray apparatus, the endoscope is pushed toward the site under investigation. To improve the overview, water is constantly injected.
The epiduroscope has several channels - the main one, optics and water. A flexible epiduroscope has an outer diameter of 2.8 mm, a viewing angle of 120 ° up and 170 ° down, a working diameter of 1.2 mm. The monitor produces a clear contrast image of what is happening in the vertebral canal, you can take photographs, document all changes and the course of the operation. It is possible to use contrast medium.
Epiduroscope
Spikes are removed mechanically - cold laser or forceps.
Possible administration of anti-inflammatory substances, stopping bleeding, taking tissue samples for histological examination.
After epiduroskopii
After the study is appointed rest, in 2-3 hours you can get up. The patient may experience pain in the incision site for a short time, headache, general weakness and in the legs. The degree of risk of intervention is discussed on the eve of the operation taking into account the individual condition of the patient. The patient receives the endoscopy result on a digital medium - disk.
Stay in the hospital - 3 days. On the day of surgery and the next three days, antibiotics are prescribed to prevent infection. Sutures are removed on the 7th day.
Within a few weeks, you need to limit physical activity. Other restrictions are associated with the detected disease and discussed individually.
Doctor neurologist Kobzeva S.V.