Epiduroscopy requires the placement of a 2mm flexible steerable endoscope through the sacral hiatus in to the epidural space around the dura. Sidefiring and forward firing laser fibres may be passed down these endoscopes and thus scarring in the epidural space surgery may be mobilised. This technique is limited in that it is limited in ability to address intradiscal and foraminal pain sources. However Rothstein is exploring methods of addressing these pain sources from this approach. Our own experience has shown that epidural inflammation or irritation is located at the foraminal level and we therefore prefer to use Endoscopic Laser Decompression & Foraminoplasty to address the pain sources with more effective instrumentation.
The posterior epidural space may be approached through a posture puncture wound in the back allowing the ligamentum flavum to be perforated. The endoscope is then passed through the ligamentum flavum allowing the posterior aspects of the epidural space to be inspected and treated by means of the same forward and side firing laser fibres passed through the endoscope. At this time this microendoscopic approach can not address the problems of axial stenosis.
