27 Clinical Outcomes of Epiduroscopy Numerous studies have shown the benefits of epiduroscopy on both quantifiable outcomes, including pain scores, functional ability, and activity rating scales, and qualitative measures, including sensory nerve function and contrast spread ( • A study in 2012 found that when compared with magnetic resonance imaging (MRI) or clinical evaluation, epiduroscopy was found to be a more reliable determinate of the vertebral level where significant spinal pathology occurs in patients with lower back and radiculopathic pain.1 This was thought to be due to the fact that epiduroscopy provides a functional indicator of pathology versus an observable indicator found on imaging modalities. • In correlating imaging and epiduroscopy, a study of 20 patients evaluated whether abnormalities identified on MRI scans could be confirmed with epiduroscopy and investigated whether targeted epidural injection of medication after adhesiolysis was able to reduce radicular pain. Epiduroscopy found adhesions in 19 of the 20 patients, 8 unobserved on previous MRI scans. Of the 20 patients, 11 showed a significant improvement in visual analog scale (VAS) scores after 3 and 12 months with epiduroscopy with adhesiolysis and steroid injection.2 • Epiduroscopy has been shown to successfully identify treatable pathology and may have a significant diagnostic and prognostic value. A study utilizing epiduroscopy for direct visual information (hyperemia, vascularity, fibrosis) and mechanical evidence (pain to touch, contrast spread, patency) was used to predict outcomes in 114 patients. By using epiduroscopy, a correct outcome was found in 78% of patients, with sensitivity in the prediction of a good or excellent outcome at 75% and specificity of no change or only a fair improvement with treatment at 82%. The study also found a sensitivity of epiduroscopy in the diagnosis of epidural pathology to be 91% but a specificity to exclude the presence of discrete epidural pathology using epiduroscopy of only 39%.3 • Nerve function testing has been performed pre- and postepiduroscopy to show whether mechanical alleviation of scar tissue can qualitatively improve sensory nerve dysfunction. Studies have shown that increased thresholds of A-β,A-δ and C fibers are found in affected dermatomes of patients with sciatica compared with unaffected dermatomes. By testing current perception threshold values of the affected lower extremity, it has been demonstrated that sensory A-β and A-δ fiber deficits improve by utilizing epiduroscopy to perform targeted adhesiolysis and epidural injection when compared with injection alone.4 This may be due to an improvement in microcirculation once the ischemia caused by the constriction has improved with the epiduroscopy or remyelination.5 • Studies show the important role mechanical adhesiolysis and decompression of the epidural space may play in patients receiving epiduroscopy. A randomized, prospective, double-blind controlled study showed significant improvement in pain relief in 80% of patients at 3 months for those who received epiduroscopy and steroid injection with adhesiolysis, compared with no relief at 3 months in the group receiving epiduroscopy and steroid injection alone.6
27.1 Introduction
Table 27.1). By investigating the diagnostic and treatment value of epiduroscopy in addition to clinical complications reported in the current clinical and scientific literature, one can further understand its usage as it applies to the pain practitioner’s therapeutic arsenal.
27.2 Diagnostic Utility
27.3 Treatment Modality
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