CAUDASCOPIC EXPERIENCES AND A NEW PATHO-ANATOMIC CONCEPT FOR TREATMENT OF SCIATICA

In order to investigate the potential of an exclusively endoscopic ext radural approach as an alternative to open discectomy, epidural endosc opy was performed in 5 cadavers. This did not produce satisfactory ima ges of the epidural space. Intradural endoscopy (caudascopy) was perfo rmed, to show whether additional anatomical factors might explain a ra dicular syndrome supplementary to or without a disc herniation. Caudas copy allowed excellent images of the cauda equina, nerve roots, and th e entrance of the lumbar nerve root sheaths. A Fogerty balloon positio ned in the intervertebral foramen was used to simulate disc herniation . The impact of this simulation on the intradural endoscopic image was observed to be minimal. A dural fold was identified at the entrance o f the nerve root sheath. It is proposed as a factor contributing to th e mechanical involvement of lumbosacral nerve roots. Pressure measurem ents in the intradural nerve root sheath support this preliminary find ing. An endoscopical management of this potential patho-anatomy of the nerve root is suggested.