Epiduroscopy:

Epiduroscopy is a relatively new method for directly visualizing the inside of the spinal column.  This is achieved by inserting a small fiberoptic catheter through a small incision along the back.  The spinal epidural space is assessed with a controllable flexible endoscope (similar to arthroscopic surgery used on knees, only a smaller device).  The contents of the spinal column are visualized on a video monitor.  Epiduroscopy may be used for diagnostic and therapeutic intervention on carefully selected patients with chronic spinal pain syndromes.  The scope allows for visualization of scar tissue (adhesions), dura mater, connective tissues, blood vessels and nerve fibers.  The study may also reveal developmental abnormalities.

Facet Arthrography:

This technique is used to determine whether pain in the back or extremities may be caused by inflammation or osteoarthritis of the spinal (facet) joints.  The procedure takes about 30 minutes to perform.  A local anesthetic agent is used to numb the area.  A small needle is placed into the facet joint then a small amount of dye is injected into the joint under X-ray (flouroscopic) guidance.  The dye is injected to verify that the needle is in the joint space.  An anesthetic agent is then injected into the joint.  It relieves symptoms and helps confirm the role of the joint relative to pain.  A positive test may be followed by injection of a therapeutic agent into the joint or use of radiofrequency denervation of the joint complex.

Fluoroscopy:

Fluoroscopy is a specialized form of X-rays using a fluoroscope, a device capable of acquiring and processing an X-ray and displaying it on a viewing screen like a television.  Fluoroscopy is routinely used for intra-operative localization of patient anatomy and surgical instrument position.  By providing this information, it promotes accurate surgical exposure for a wide variety of procedures.  The shape of the fluoroscopy unit is usually C-shaped (known as a C-arm) providing for flexible viewing of the area in question from any angle.  Spine specialists often use this form of imaging to help guide needles and scopes to precise locations when performing interventional procedures such as discography or spinal injections.  The C-arm can easily be positioned to take unique X-ray pictures of the patient on the table.  Digital videoflouroscopy (DVF) may be used to assess spinal biomechanics.

Despite its widespread acceptance and use fluoroscopy does have some disadvantages; the most notable is occupational radiation exposure and the other being that only a single real–time planar view is usable at any given time.  For procedures requiring multi-planar fluoroscopic visualization such as percutaneous transpedicular biopsy, the C–arm has to be positioned and repositioned many times during the procedure.  This repositioning process is often tedious and time–consuming.  In an ideal situation, the physician holds an instrument perfectly still in one plane while correcting its position in the other.  The X–ray technologist then repositions the fluoroscope to obtain the perfect view in each desired plane.  By combining current C–arm fluoroscopy with computer–aided technology, many benefits of fluoroscopy can be maximized, while minimizing or limiting its shortcomings.