Kim DH, Abdi S, Schütze G. Epiduroscopy: Atlas of ProceduresThieme; 2017; 261 pp; 600 ill; $139.99

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Epiduroscopy is a minimally invasive, percutaneous technique that provides an alternative to open surgery in a select group of patients. Those suffering from a myriad of conditions causing low back pain, radiculopathy, and failed back syndrome are a few examples.

The latest advances in endoscopic equipment and specialized tools allow direct access to the epidural space with extremely low-profile, narrow-caliber instruments. This allows surgeons direct visualization of the pathology, making diagnosis and treatment of neuraxial-related pain syndromes possible.

The authors of this 244-page textbook come from diverse medical backgrounds. The combined knowledge from neurosurgery, anesthesiology, and pain management provides a detailed text on the salient aspects involved in setting up an epiduroscopy service.

Divided into 27 erudite chapters, the early chapters deal with the history of epiduroscopy and its evolution into an alternative procedure to open surgery.

A textbook on the management of spinal pain syndromes would not be complete without a detailed revision of the anatomy of the spinal axis. In addition, a review of applied radiologic anatomy of the neurospinal axis is detailed, interesting, and informative as it pertains to spinal endoscopy.

The authors reference the fact that information gleaned from imaging itself is often not sufficient to diagnose the source of back pain and pain syndromes. Positive imaging findings may not always correlate with the symptoms. This is where spinal endoscopy may be useful—in identifying conditions that may not show well on conventional imaging techniques. Pathologic entities such as adhesions and scar formation are a few given examples. The procedure of epiduroscopy has the ability to diagnose and treat these conditions with minimal invasion.

Detailed theoretical accounts of the pathophysiology of spinal pain and anatomic pain pathways provide the reader with further insight into treatment of pain syndromes. The complex concept of biochemical afferent nociceptive pain generation and its pathways are discussed.

With some of the theory learned in the earlier chapters, the text moves into discussing how pain syndromes may manifest based on anatomic origin.

Details of the equipment needed to perform spinal endoscopy are included, and features of the most commonly used modern equipment are discussed further. Differences, pros, and cons of each endoscope are explored.

The subsequent chapters deal with clinical aspects of a spinal endoscopic practice. Indications and clinical considerations for choosing the appropriate patient are discussed. Continuing on with a clinically oriented theme, further sections cover pre- and intraprocedural steps, as well as anesthetic management during epiduroscopy.

The latter part of the textbook discusses specific pathologies, with intraoperative pictures and radiologic images for correlation. Additional diagrams are also included to illustrate specific points.

Diagrams, images, and illustrations are generally clear, well labeled, and include annotations. Actual intraoperative pictures, however, are not well annotated and not as clear, especially to the reader untrained in these procedures.

Overall, the neuroradiology audience should find this textbook informative. The sections on spinal anatomy revision and the detailed descriptions of pathophysiology and anatomic pathways of pain generation are definitely of value to this audience. Subsequent sections dealing with the specifics of spinal endoscopy and the clinical aspects of the procedure are perhaps less so. However, the fact that such a procedure even exists may be the most valuable lesson this text offers.

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