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Posted by MLWhitworth, M.D. on March 03, 2000 at 23:58:43:

In Reply to: Re: QUESTIONS FO DR. WHITWORTH posted by Kim on March 03, 2000 at 23:02:57:

Epiduroscopy attempts to approach the peridural fibrosis in the epidural space via the caudal canal which is entered through the sacrococcygeal ligament (a membrane between the sacrum and the coccyx, ie. tailbone). The scope is placed in the caudal canal and is advanced into the area of the scar tissue in the epidural space. Scar tissue is visualized, epidural steroids may be injected directly into the area, but the problem with traditional epiduroscopy is that blunt dissection is used with the end of the catheter guide to literally rip the scar tissue off the nerve roots. Often this causes more bleeding, fibrosis, and more scar tissue, so this use of the epiduroscope is not optimal. A new Holmium YAG lasar can be used to dissect with a lasar beam sharp dissection which also cauterizes at the same time to reduce bleeding. This is the optimal way to do epiduroscopy. If the lasar is not used and instead sharp tools such as microscissors are used through the scope or guide, the nerves can be accidentally cut (poor form!). If blunt dissection is used, bleeding and abrasion of the nerve root can occur. With a lasar, the penetation is limited to 0.35mm which is small enough to avoid nerve damage. I would not perform epiduroscopy without lasar because otherwise, it is very much like the blunt dissection of a Racz catheter with no clear advantage. The scope is FDA approved for lasar use, but your doc may not be aware of this. A Racz procedure uses a stiff wire catheter to ram through scar tissue and deliver steroids to the nerves. The Racz is known to have a very low 6 and 12 month effectiveness rate.

: : Two other options: epiduroscopy with lysis of adhesions via Holmium YAG lasar or lasar foraminoplasty via endoscopic approach.
: : I will be training to do the former in the next few months and the latter in April with a Dr. in Britain that has performed over 3,000 of these operations. When I find out the best in the world names, I will let you know. I will post here.
: Dr. Whitworth, Thank you for a prompt and concise reply. I have had the epiduroscopy suggested recently and am going to see a DR that my pain management DR reffered me to as he has never performed one. Would you be kind enough to explain how epiduroscopy differs from razcs procedure. I could not find any good info on web.
: Thank you for your time. Kim
: : : Good day DR. Whitworth. I have cervical lumbar problems but right now lumbar is accute.I have had two laminectomys at L5S1. First one 15 years ago and second one in 1998. Have developoed acute radiculopathic pain caused by epidural fibrosis. This is shown in post OP MRI, CT and Myelogram and is also proven by obvious symptomology. Razcs Procedures failed to do the job. Have researched this much and think there may now be a way to surgicaly remove lesions from exit foraminae and free S1 nerve root of compression. In this day and age there must be a Dr. who knows how to do this and also prevent recurring fibrosis at same area. Please try to find info for me. My left leg is just like an artificicial limb right now. Very little strength in it. Atrophy has and is occurring. Pain is awfull. Need help soon, must get healthy and back to work. Thank you. Kim

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