Pain-free thanks to epiduroscopy

A tried-and-tested method for chronic pain

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Chronic back pain can severely restrict daily life and often leave sufferers feeling desperate when conventional treatments fail to work. One innovative treatment method is epiduroscopy – a minimally invasive procedure that specifically identifies and treats adhesions and scarring within the spinal canal.

In this interview, Dr Wolfgang Welke, Head of the Centre for Specialised Pain Medicine at the Sportklinik Hellersen, explains how this technique works, when it is used and what opportunities it offers patients.

Dr. Welke, what exactly happens during an epiduroscopy?
Dr. Wolfgang Welke: Epiduroscopy is a minimally invasive procedure for visualising the spinal canal. This means that we can use a very fine optical device – known as a fibre-optic scope – to visualise the spinal canal on a monitor from the sacrum. This allows adhesions, fibrosis and other pathological hardening of connective tissue, and in some cases treated directly. Scarring following disc surgery or narrowing of the spinal canal can also be detected in this way.

Why do these scars cause problems?
Dr. Wolfgang Welke: The scar tissue often irritates the meninges in the area of the so-called meninges sac all the way to the sacrum. This frequently leads to irritation of the spinal nerve. With the help of epiduroscopy and subsequent catheter-based pain management we can specifically target this irritation.

Can you give an example of how it is handled?
Dr. Wolfgang Welke: These days, the endoscopes are very small and manoeuvrable. We guide the lens through a small tube placed in the sacrum to the affected area. Using irrigation we can reach the nerve root and release adhesions. Special fascial forceps or balloon catheters help to create space for constricted nerves. This often provides immediate pain relief.

“In Germany, there are only a few centres that offer this procedure. Our Pain Centre at the Sportklinik Hellersen is one of them.”

Dr. Wolfgang Welke
Chief of Special Pain Medicine

What is the main advantage of this method?
Dr. Wolfgang Welke: Epiduroscopy is a minimally invasive procedure. Access is gained via an incision of just five millimetres. Through this, the small tube through which the endoscopes operate is inserted. This allows us to work as far as the neck area. We then insert a pain catheter precisely at the affected site. This remains in place for seven days, and twice daily infusions, sometimes containing cortisone, are administered to reduce the nerve pain. It is therefore a targeted treatment for irritated nerve roots, particularly in cases of fibrosis and scarring within the spinal canal.

How widespread is this method in Germany?
Dr. Wolfgang Welke: In Germany, there are only a few centres that offer this procedure. Our pain centre at the Sportklinik Hellersen is one of them – at least within a radius of 250 kilometres. We perform epiduroscopy on around 200 to 250 patients a year.

Video: Pain-free thanks to epiduroscopy