Lumbosacral Epiduroscopy Findings Predict Treatment Outcome

Bosscher, Hemmo A.; Heavner, James E.

doi:10.1111/papr.12112

Cited by 24 publications

(31 citation statements)

References 26 publications

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“…Presence of CGRP and SP positive nerve fibers and demonstration of small unmyelinated nerve fibers using electron microscopy, suggests that these fibers have nociceptive function. This is consistent with epiduroscopy findings (Bosscher and Heavner, ) as well as pain relief obtained by percutaneous ablation and curettage of the intervertebral foramen (PACIF) in humans with chronic low back pain (Bosscher and Heavner, ).…”

Section: Discussionsupporting

confidence: 89%

The Peridural Membrane of the Human Spine is Well Innervated

Bosscher

Heavner

Grozdanov

et al. 2016

The Anatomical Record

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There is evidence that low back pain may originate from a peridural membrane (PDM) at the inferior and medial aspect of neural foramen of the lumbar spine. The objective of this investigation was to determine if this membrane contains neural elements suggestive of sensory innervation with nociceptive function. Spines of four embalmed and three non-embalmed human cadavers were dissected using a sagittal approach to the neural foramen. Seventeen samples of the peridural membrane overlying the neural foramen were collected for immunohistochemistry (IHC) examination by light microscopy and transmission electron microscopy (TEM). Chromagin tagged antibodies to protein gene product 9.5 (PGP9.5) and S-100, and fluorescent antibodies to substance P and calcitonin gene related peptide (CGRP) were used to label neural structures in tissue sections cut from paraffin embedded blocks. This approach allows good visualization of all neural elements, small sensory, and nociceptive nerve fibers in particular. Neural elements were found in all samples. Marked presence of small nerve fibers was observed in 12 of 15 samples. IHC and TEM evaluation revealed myelinated as well as unmyelinated fibers in the peridural membrane. CGRP and substance P immunoreactive fibers indicative of nociceptive function were abundant. These findings confirm and expand evidence that the peridural membrane in human is well innervated and contains sensory nociceptive nerve fibers suggestive of a nociceptive function of the membrane.

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Section: Discussionsupporting

confidence: 89%

The Peridural Membrane of the Human Spine is Well Innervated

Bosscher

Heavner

Grozdanov

et al. 2016

The Anatomical Record

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“…In 31 patients (88.5%), epidural fibrosis was confirmed with epiduroscopy. We encountered severe fibrosis in 18 patients (51.4%), and mild fibrosis in 13 patients (37.1%) . After epiduroscopic lysis of adhesions, full and partial adhesiolysis was accomplished in 13 (37.1%) and 11 (31.4%) of the cases, respectively (see Table ).…”

Section: Resultsmentioning

confidence: 96%

“…Outcome of treatment can be predicted accurately in the majority of patients based on selected visual (hyperemia, changes in vascularity, fibrosis) and mechanical (concordant pain, contrast spread, patency) diagnostic parameters …”

Section: Discussionmentioning

confidence: 99%

Does the Use of Epiduroscopic Lysis of Adhesions Reduce the Need for Spinal Cord Stimulation in Failed Back Surgery Syndrome? A Short‐Term Pilot Study

et al. 2018

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“…Bosscher and Heavner evaluated the significance of epiduroscopic findings in predicting the outcome of the treatment, suggesting that information obtained through epiduroscopy may carry significant diagnostic and prognostic value . However, only 12 patients (8.6%) of their study population had previous spine surgery, and therefore, these results cannot reliably be extrapolated to patients with FBSS.…”

Section: Discussionmentioning

confidence: 99%

Results of Lumbar Endoscopic Adhesiolysis Using a Radiofrequency Catheter in Patients with Postoperative Fibrosis and Persistent or Recurrent Symptoms After Discectomy

et al. 2014

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Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.

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Lumbosacral Epiduroscopy Findings Predict Treatment Outcome

Abstract: Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value.

Cited by 24 publications

References 26 publications

The Peridural Membrane of the Human Spine is Well Innervated

The Peridural Membrane of the Human Spine is Well Innervated

Does the Use of Epiduroscopic Lysis of Adhesions Reduce the Need for Spinal Cord Stimulation in Failed Back Surgery Syndrome? A Short‐Term Pilot Study

Results of Lumbar Endoscopic Adhesiolysis Using a Radiofrequency Catheter in Patients with Postoperative Fibrosis and Persistent or Recurrent Symptoms After Discectomy

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