Epidural space and chronic pain

Epidural fibrosis, flogosis, hyperemia and stasis, are some of the pathological morphologies that can be found in the epidural space (ES) of patients affected from failed back surgery syndrome (FBSS), stenosis and other chronic painful pathologies, usually grouped in the class of low back pain (LBP) syndrome. As a consequence of lumbar spine surgery fibrotic tissue commonly replace epidural fat, and large amounts of scar tissue are found around nerve roots. The diagnostic tools currently available, magnetic resonance imaging (MRI) and computer tomography (CT) are dramatically poor, and allow only the definition of pathological structural contents. The only method for monitoring the dura anatomy is during the epiduroscopy, which has been revalued only recently for the diagnosis and the treatment of FBSS. In 2001 we introduced a new endoscopic technique (the Raffaeli method) for the lysis of adhesions under direct imaging, and the study of normal and pathological morphologies of the dura.