Epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, is an endoscopic procedure in which the epidural space is explored for the purpose of diagnosing and treating spinal pain, specifically radicular pain. A steerable or controllable flexible endoscope is used to examine the epidural anatomic structures to find epidural adhesions, fibrosis and scars, and to provide precision directed therapy. 

Note: Please see the following related document for additional information:

• SURG.00072  Lysis of Epidural Adhesions

Investigational and Not Medically Necessary:

Epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, is considered investigational and not medically necessary.

There is insufficient scientific evidence in the peer-reviewed medical literature to determine the safety and efficacy of epiduroscopy as a diagnostic procedure or as a technique to guide interventional therapy.

Dashfield and colleagues (2005) reported on a study randomizing 60 participants with sciatica to undergo steroid injection with or without epiduroscopy guidance. No significant differences in outcomes were identified between the two groups. Ruetten and colleagues (2003) used epiduroscopy to guide intervention in 93 participants with chronic back-leg pain syndrome. Intervention was performed when considered appropriate; therefore, this study does not permit analysis of the contribution of epiduroscopy to the overall treatment. In a review article, Gill and colleagues (2005) reported on visual impairment as a complication of epiduroscopy, considered a rare but significant complication of the procedure. Their review identified 12 cases reported in the literature where a bolus injection of fluid resulted in a sudden increase in cerebrospinal fluid pressure ultimately compressing the optic nerve.    

Epiduroscopy also known as epidural spinal endoscopy or epidural myeloscopy, is an invasive procedure that involves the insertion of a miniature fiberoptic scope into the epidural space. This device was approved by the U.S. Food and Drug Administration (FDA) in 1996. Epiduroscopy allows direct visualization to examine the epidural space for pathology (e.g. adhesions) that would contribute to chronic low back pain or radiculopathy. Although the procedure is mainly used for the visualization of the epidural space, treatments such as mechanical or laser lysis of spinal adhesions or introduction of steroids to areas of inflamed tissues may also be performed. The claimed benefits of epiduroscopy are that it may be used both as a diagnostic as well as an intervention for low back pain.

Endoscope: A highly flexible viewing instrument with capabilities of diagnostic and therapeutic functions through special channels. 

Endoscopy: The visual inspection of any cavity of the body by means of an endoscope.

Radiculopathy: Any disease of the spinal nerve roots and spinal nerves; radiculopathy is characterized by pain which seems to radiate from the spine to extend outward to cause symptoms away from the source of the spinal nerve root irritation; causes of radiculopathy include deformities of the discs between the building blocks of the spine (the vertebrae).

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Investigational and Not Medically Necessary:
When the code describes a procedure indicated in the Position Statement as investigational and not medically necessary.

Peer Reviewed Publications:

1. Dashfield AK, Taylor MB, Cleaver JS, Farrow D.  Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial. Br J Anaesth. 2005; 94(4):514-519.
2. Gill JB, Heavner JE. Visual impairment following epidural fluid injections and epiduroscopy: a review. Pain Med. 2005; 6(5):367-374.
3. Ruetten S, Meyer O, Godolias G. Endoscopic surgery of the lumbar epidural space (epiduroscopy): results of therapeutic intervention in 93 patients. Minim Invasive Neurosurg. 2003; 46(1):1-4. 

Epidural Myeloscopy
Epidural Spinal Endoscopy
Epiduroscopy