The efficacy of epiduroscopic neural decompression with Ho:YAG laser ablation in lumbar spinal stenosis

Endoscopic Epidurolysis for the Management of Chronic Spinal Pain: A Delphi-Based Italian Experts Consensus

INTRODUCTION

Endoscopic epidurolysis (EE) is a minimally invasive procedure used to manage chronic spinal pain, particularly in cases unresponsive to traditional treatments. Despite its growing recognition, the literature lacks comprehensive guidelines on its optimal use. This study utilized a modified Delphi approach to gather expert consensus on best practices for EE in the Italian pain therapy network.

METHODS

The study's scientific board conducted an extensive literature review to define key investigation topics, including clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was developed and administered to a panel of experts. A two-round Delphi process was implemented, with consensus defined as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements that did not reach consensus in the first round were rephrased and resubmitted in the second round.

RESULTS

Twenty-six clinicians participated in the study, with a 100% response rate in both rounds. In the first round, consensus was achieved for 9 out of 19 statements. In the second round, 8 out of 10 rephrased statements reached the consensus threshold. Key areas of agreement included the clinical indications for EE, the importance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, consensus was not reached on the use of EE for disc herniation with radicular pain and the safety of interlaminar access compared to sacral hiatus access.

CONCLUSION

The study highlights the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain. The consensus reached by the expert panel provides a framework for best practices, which can guide clinical decision-making and improve patient outcomes. Further research is necessary to validate these findings and address areas where consensus was not achieved.

Is trans-sacral endoscopic laser decompression truly effective? Clinical and functional assessment of a single spine center

Background

Herniated nucleus pulposus (HNP), without causing significant neurological deficit, is a more frequently occurring disease of the spine affecting the activities of daily living with chronic back pain and sometimes progressing to produce significant functional deficit. Trans-sacral epiduroscopic laser decompression (SELD) is being increasingly used as a treatment modality for these conditions and has been shown to give effective results. We present the clinical outcomes of the patients undergoing SELD in our institute for HNP.

Methods

A retrospective study of 411 patients who underwent SELD for lumbar disc herniation was done, analyzing the clinical outcomes by measuring visual analog scale (VAS) scores for leg pain and back pain, Oswestry Disability Index (ODI) score, and Short form health survey (SF -36) scores and followed up for 6 months.

Results

A total of 195 males and 216 females underwent SELD, with a mean age of 33.2 ± 0.9 years and a mean follow-up period of 7 ± 1.6 months. VAS scores for back pain and leg pain improved significantly from 6.9 ± 0.5 and 6.6 ± 0.6 preoperatively to 1.1 ± 0.5 (P > 0.05) and 0.4 ± 0.5 (P > 0.05) at 6 months. ODI score decreased from 28.2 ± 1.7 to 9.4 ± 1.7 at 6 months from the intervention (P < 0.05). SF-36 showed significant improvement in overall categories through 6 months of follow-up. Twenty-four patients had dural punctures, and four patients needed blood patches but recovered without any complications. One patient had aggravation of the disc herniation post-procedure, and was managed by endoscopic discectomy.

Conclusion

SELD is a safe, accurate, and effective procedure in treating symptomatic lumbar disc herniation with excellent clinical outcomes and effective pain relief with minimal damage to paraspinal muscles with an easier learning curve, reproducible results, and high safety index.

Trans-Sacral Epiduroscopic Ho:YAG Laser Ablation of the Ligamentum Flavum in a Live Pig

Introduction

For the aging population, surgery for lumbar spinal canal stenosis (LSCS) requires minimally invasive procedures. Recently, trans-sacral epiduroscopic laser decompression for lumbar disc herniation has been reported with good results. In this study, we devised a new method to perform trans-sacral epiduroscopic laser ablation of the ligamentum flavum (LF), known to be the major cause of LSCS. Using a live pig, this study aims to evaluate the efficacy, safety, and drawbacks of this procedure.

Methods

Using an epiduroscope, we observed intra-spinal canal structures and then examined the feasibility and problems of a decompression procedure to ablate the LF using holmium:YAG (Ho:YAG) laser. The pig was observed for behavioral changes and neurological deficits after the procedure. Histological analysis was performed to evaluate the amount of tissue ablation and damage to surrounding tissues.

Results

Although it was possible to partially ablate the LF using the Ho:YAG laser under epiduroscopy, it was difficult to maintain a clear field of view, and freely decompressing the target lesion has been a challenge. After the first two experiments, the pig neither showed abnormal behavior nor any signs of pain or paresis. However, in the third experiment, the pig died during the operation. On autopsy, no thermal or mechanical injury was noted around the ablated site, including the dura mater and nerve root. Histological analysis showed that the LF and lamina were deeply ablated as the laser power increased, and no damage was noted on surrounding tissues beyond a depth of 500 μm.

Conclusions

Although Ho:YAG laser could ablate the ligamentum and bone tissues without causing damage to surrounding tissues, it was difficult to completely decompress the LF under epiduroscopy. This method is a potentially highly invasive procedure that requires caution in its clinical application and needs further improvement in terms of the instruments and techniques used.

Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation

Objective

Previous literatures have demonstrated widely variable clinical results after transsacral epiduroscopic laser decompression (SELD) and the factors predicting outcomes are not yet established. Therefore, we analyzed the clinical outcome and associated predictive factors of SELD in patients with lumbar disc herniation.

Methods

Between 2015 and 2018, 82 patients who underwent single-level SELD and followed up at least 6 months were enrolled. The overall success rate (excellent or good results at final follow-up) was 58.5% according to Odom’s criteria. Based on this result, patients were divided to 2 groups: a favorable group (n = 48) and an unfavorable group (n = 34). A retrospective review of the baseline characteristics and clinical outcome were conducted to reveal the predictive factors.

Results

As expected, improvement of pain and patient satisfaction, was more favorable in the favorable group (p < 0.05). Moreover, the rate of additional procedure was lower in the favorable group (4.2%, 2 of 48 patients) than in the unfavorable group (35.3%, 12 of 34 patients) (p = 0.011). Among the various baseline characteristics, the only significant predictive factor for favorable outcome was the presence of a high-intensity zone (HIZ) on preoperative magnetic resonance imaging (50.0% [24 of 48 patients] in the favorable group vs. 11.8% [4 of 34 patients] in the unfavorable group; odds ratio, 15.67; p = 0.024).

Conclusion

Although SELD for lumbar disc herniation resulted in a less favorable clinical outcome than that reported in previous studies, in patients with a HIZ, SELD can be an effective minimally invasive surgery to relieve low back pain and/or leg pain.

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

BACKGROUND

Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.

METHODS

Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.

RESULTS

According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825-(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12-64.78 in the early group versus mean 45.34 min; 95% CI, 42.45-48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.

CONCLUSION

The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

Outcomes of epiduroscopic laser ablation in patients with lumbar disc herniation

Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom's criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom's criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

Objective

Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results.

Methods

Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom's criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed.

Results

Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). According to Odom's criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up.

Conclusion

Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

A Novel Combination Technique: Three Points of Epiduroscopic Laser Neural Decompression and Percutaneous Laser Disc Decompression With the Ho:YAG Laser in an MSU Classification 3AB Herniated Disc

AIM

The aim of this study was to examine the effects of simultaneous epiduroscopic laser neural disc decompression (ELND) and percutaneous laser disc decompression (PLDD) applications using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser in Michigan State University (MSU) classification 3AB herniated discs on VAS and Oswestry Disability Index (ODI) scores.

METHODS

In this prospective observational study, ELND and PLDD procedures performed between January 2016 and December 2017 were examined. Preoperative, postoperative week 2, postoperative month 2, and postoperative month 6 ODI and VAS scores were obtained from patient files, and postoperative month 12 ODI and VAS scores were obtained from face-to-face interviews with patients and recorded.

RESULTS

The data of 41 patients treated with simultaneous ELND and PLDD using a Ho:YAG laser were included in this study. Postoperative VAS scores of the patients were compared with preoperative values, and it was found that postoperative week 2, postoperative month 2, postoperative month 6, and postoperative month 12 VAS and ODI scores were significantly different compared to preoperative scores (P = 0.001; P < 0.01). 17.1% (n = 7) of the patients had a history of postoperative open surgery. Although dural puncture occurred in 7 patients (17%), only 1 patient had headache.

CONCLUSION

We believe that the new combined technique of ELND and PLDD using a Ho:YAG laser is a reliable method in patients with MSU classification 3AB herniated discs, with an acceptable success rate and a low complication rate within 12 months after treatment. We think that randomized controlled studies are required for this method to be included in treatment algorithms.

Effects of Ho:YAG Laser Ablation on Postoperative Low Back Pain and Functional Status After Transforaminal Endoscopic Lumbar Discectomy: Minimum of 2-Year Follow-Up

OBJECTIVE

To evaluate effects of holmium:yttrium-aluminum-garnet (Ho:YAG) laser ablation on postoperative low back pain and improving functional status in patients with lumbar disc herniation undergoing transforaminal endoscopic lumbar discectomy (TELD).

METHODS

The study enrolled 220 patients with lumbar disc herniation who underwent TELD or TELD with Ho:YAG laser from August 2015 to September 2016. Parameters including operative time, hospitalization, complications, and recurrence were recorded. Clinical outcomes were assessed according to visual analog scale for back pain and leg pain, Oswestry Disability Index for functional status, and modified MacNab criteria for patient satisfaction.

RESULTS

Minimal 2-year follow-up was completed by 186 patients: 76 patients who underwent TELD and 110 patients who underwent TELD with Ho:YAG laser. In the group undergoing TELD, clinical outcomes of back pain and functional status exhibited a V-shaped upward trend after surgery; there were no statistically significant differences in visual analog scale for back pain and Oswestry Disability Index scores at final follow-up compared with preoperatively (P > 0.05). In the group undergoing TELD with Ho:YAG laser, postoperative visual analog scale for back pain and Oswestry Disability Index scores significantly improved compared with preoperatively (P < 0.05) exhibiting relatively consistent improvement after surgery. The only laser-related complication was a burning sensation in the ipsilateral lower limb during the thermal procedure in 2 cases.

CONCLUSIONS

Performing Ho:YAG laser ablation with TELD prolonged low back pain relief and improved functional outcome during 2-year follow-up compared with TELD alone in patients with symptomatic lumbar disc herniation.

Clinical Efficacy and Safety of Trans-Sacral Epiduroscopic Laser Decompression Compared to Percutaneous Epidural Neuroplasty

Percutaneous epidural neuroplasty (PEN) is an effective and safe procedure for herniated lumbar disc (HLD). Although PEN has an advantage of adhesiolysis, this procedure cannot decompress the protruded disc. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative methodology. This study evaluated the clinical efficacy and safety of SELD compared to PEN, as well as the change in protruded disc volume after SELD through pre- and postoperative magnetic resonance imaging (MRI), in patients with HLD. Thirty consecutive patients underwent SELD (SELD group), and 45 patients underwent PEN (PEN group). The Visual Analog Scale (VAS) for leg pain; Oswestry Disability Index (ODI); 12-Item Short-Form Health Survey (SF-12); preoperative and postoperative 4-, 12-, and 24-week Macnab criteria; and preoperative and 24-week postoperative lumbar spinal MRIs after SELD were obtained. There was no significant difference in age, sex, duration of symptoms, and the distributions of disc level between the two groups (all P > 0.05). Between the SELD and PEN groups, preoperative VAS, ODI, and SF-12 scores had no significant differences. However, the VAS, ODI, and SF-12 scores improved significantly after the procedures by postoperative week 24 in each group (all P < 0.05). Furthermore, improvements of VAS, ODI, SF-12, and success rate of Macnab criteria in the SELD group were better than those in the PEN group (all P < 0.05). The protruded disc volume after SELD decreased significantly (P=0.034). All clinical and functional outcomes of patients undergoing SELD and PEN for HLD improved following the procedures. Notably, SELD was superior to PEN regarding the degree of improvement in clinical and functional outcomes. Therefore, we suggest that SELD can be used as an effective alternative to PEN to provide improved clinical and functional outcomes in patients with HLD.

Sacral epiduroscopic laser decompression for complex regional pain syndrome after lumbar spinal surgery: A case report

RATIONALE

CRPS after a lumbar surgery has symptoms that are similar to PSSS. However, standard criteria for distinguishing CRPS from PSSS do not exist. We present a case report of a 31-year-old female with CRPS symptoms after lumbar spinal surgery treated by performing SELD.

PATIENT CONCERNS

This patient was referred to our pain clinic for left ankle pain. She received a lumbar discectomy for a herniated lumbar disc (L5/S1) but the pain was aggravated after surgery.

DIAGNOSES

The characteristics of the pain were burning, tingling, and cold, and were accompanied by other symptoms such as swelling, color change and mail dystrophy. The patient was diagnosed with CRPS.

INTERVENTIONS

Medications and interventional therapies were not effective in reducing pain. SELD was performed and severe adhesive inflammation was observed in the L4-S1 epidural space. We performed mechanical adhesiolysis and injected hyalurodinase and dexamethasone near the L5 and S1 root. One month after, a second SELD was performed as same manner.

OUTCOMES

After second SELD, the patient's pain markedly decreased. On the second visit in the outpatient clinic, the patient was absent of pain without any other medications.

LESSONS

CRPS like symptoms can appear after lumbar spinal surgery due to adhesion and inflammation in the epidural space. In such cases, SELD can be considered as diagnostic and therapeutic option.

The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients

Background

Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome.

Methods

A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy.

Results

All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group.

Conclusions

Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation

Context/Objective: Trans-sacral epiduroscopic laser decompression (SELD) is an alternative to microscopic open lumbar discectomy (OLD). SELD and OLD for L5-S1 lumbar disc herniation (LDH) have not been compared. We compared clinical results, including pain control, between SELD and OLD.Design: Retrospective analysis.Setting: Korean hospital.Participants: Eighty patients treated with SELD (n = 40) or microscopic OLD (n = 40) for L5-S1 LDH.Interventions: N/A.Outcome Measures: Clinical data were compared over 6 months. Functional status was evaluated using Oswestry Disability Index (ODI, 0-100%) and time to return to work. Preoperative and postoperative pain was measured using a visual analog scale (VAS, 0-10). Radiological assessment was performed preoperatively and postoperatively.Results: The ODI and VAS scores for leg and back pain significantly improved in both groups. At 6-months after the procedure, the average ODI decreased to 13.2 ± 11.2 from 54.5 ± 14.5 for SELD and 9.5 ± 10.4 from 57.5 ± 16.0 for OLD. The average leg VAS decreased to 1.9 ± 1.2 from 6.0 ± 1.4 for SELD and 2.3 ± 1.3 from 6.7 ± 1.6 for OLD. Back VAS reduced to 2.6 ± 1.3 from 7.2 ± 1.5 for OLD. Time to return to work was 1.1 ± 1.1 weeks for SELD and 5.4 ± 2.1 weeks for OLD. Clinical outcomes of SELD were non-inferior to those of OLD in terms of pain control.Conclusion: A scar-free procedure and early return to normal life are advantages of SELD.

Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study

Background

Trans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. However, the complications associated with SELD have not been comprehensively evaluated to date. Therefore, the aim of our study was to describe the incidence rate, types, and characteristics of complications following SELD and management outcomes.

Methods

Retrospective analysis of the surgical and clinical outcomes for 127 patients (average age, 42.2 ± 15.2 years) who underwent SELD for LDH at L2-3, L3-4, L4-5, and/or L5-S1, performed by a single experienced spine surgeon at a single center, between January 2015 and April 2017, was conducted.

Results

All procedures were successful, with a mean follow-up of 12.3 ± 2.3 months. Complications were identified in 8 patients (6.3%), including 3 cases of incomplete decompression (2.4%), 2 cases of recurrent disc herniation (1.6%), and one case each of hematoma, dural tearing, and subchondral osteonecrosis (0.8%). Among these cases with complications, only 2 cases with incomplete decompression and one case with recurrent LDH did not improve with conservative treatment and required re-operation using an open approach. The rate of complications decreased from 12.6% when considering only the first 50 cases to 2.6% for cases 51–127.

Conclusions

Incomplete decompression, recurrent herniation, epidural hematoma, dural tear, and subchondral osteonecrosis were identified as complications of SELD, although the overall rate of complications was low. Practice with the procedure and careful patient selection can lower the risk of complications.

Magnetic Resonance Thermometry and Laser Interstitial Thermal Therapy for Brain Tumors

Recent technological advancements in intraoperative imaging are shaping the way for a new era in brain tumor surgery. Magnetic resonance thermometry has provided intraoperative real-time imaging feedback for safe and effective application of laser interstitial thermal therapy (LITT) in neuro-oncology. Thermal ablation has also established itself as a surgical option in epilepsy surgery and is currently used in spine oncology with promising results. This article reviews the principles and rationale as well as the clinical application of LITT for brain tumors. It also discusses the technical nuances of the current commercially available systems.

Evaluation of epiduroscopy for detection of vertebral canal and spinal cord lesions in dogs

OBJECTIVE To evaluate the potential usefulness of epiduroscopy for clinical diagnosis and treatment of vertebral canal and spinal cord lesions in dogs. SAMPLE Cadavers of 6 mixed-breed dogs. PROCEDURES Dogs were positioned in sternal recumbency, and an endoscope was introduced into the lumbosacral epidural space. A fiberscope (diameter, 0.9 mm; length, 30 cm) was used for 3 dogs, and a videoscope (diameter, 2.8 mm; length, 70 cm) was used for the other 3 dogs. Visibility and identities of anatomic structures were recorded, and maneuverability of the endoscopes was assessed. Extent of macroscopic tissue damage was evaluated by manual dissection of the vertebral canal at the end of the procedure. RESULTS Intermittent saline (0.9% NaCl) solution infusion, CO2 insufflation, and endoscope navigation improved visualization by separating the epidural fat from the anatomic structures of interest. Images obtained with the fiberscope were small and of poor quality, making identification of specific structures difficult. Maneuverability of the fiberscope was difficult, and target structures could not be reliably reached or identified. Maneuverability and image quality of the videoscope were superior, and spinal nerve roots, spinal dura mater, epidural fat, and blood vessels could be identified. Subsequent manual dissection of the vertebral canal revealed no gross damage in the spinal cord, nerve roots, or blood vessels. CONCLUSIONS AND CLINICAL RELEVANCE A 2.8-mm videoscope was successfully used to perform epiduroscopy through the lumbosacral space in canine cadavers. Additional refinement and evaluation of the technique in live dogs is necessary before its use can be recommended for clinical situations.

A preliminary study on surgical navigation for epiduroscopic laser neural decompression

Epiduroscopic laser neural decompression is an emerging therapeutic modality to treat lumbar spine pathologies including chronic low back pain, spinal stenosis, and disk herniation via catheter insertion followed by laser ablation of the lesion. Despite the efficacy of epiduroscopic laser neural decompression, excessive radiation doses due to fluoroscopy during epiduroscopic laser neural decompression have limited its widespread application. To address the issue, we propose a surgical navigation system to assist in epiduroscopic laser neural decompression procedures using radiation-free image guidance. An electromagnetic tracking system was used as the basic modality to track the internal location of the surgical instrument with respect to the patient body. Patient-to-image registration was carried out using the point-based registration method to determine the transformation between the coordinate system of the patient and that of the medical images. We applied the proposed system in epiduroscopic laser neural decompression procedures to assess its effectiveness, and the outcomes confirmed its clinical feasibility. To the best of our knowledge, this is a report on the first surgical navigation applied for epiduroscopic laser neural decompression procedure.