Epiduroscopy demonstrates that the prevalence of severe epidural fibrosis after FBSS is substantially higher than is generally reported in MRI evaluations. Severe epidural fibrosis is an underlying pathology in most patients with FBSS.

There exists substantial evidence that a peridural membrane (PM) is present in the spinal canal of humans and, like the pleura and peritoneum, has one or more physiologic functions. Innervation of the PM suggests that it may become a source of pain if injured. Although debated, the physiology of this structure has important implications with respect to neuraxial distribution of drugs and for back and radiating pain. This review, separated into embryological, anatomic, and physiologic discussions, provides an in-depth summary of the observations of this connective tissue. The discrepancies between accounts are highlighted within each section. Focused research to clearly elucidate the true nature of the PM, especially as related to neuraxial distribution of drugs and back and radiating pain, is warranted.

Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value.

Results of this study indicate that epiduroscopy is more reliable than is either clinical evaluation or MRI for determining the vertebral level where clinically significant spinal pathology occurs in patients with LBP/RP.

Visceral pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain independent of its etiology. Five major pathways by which pelvic pain is transmitted can be identified. One of them, the superior hypogastric plexus, an extension of the preaortic plexus, is easily assessable to blockade by local anesthetics and neurolytic agents. Several techniques have been described. Long-lasting pain relief with this procedure has been achieved in patients with pelvic cancer pain. However, there is a discrepancy between diagnostic and therapeutic blockade in patients with nonmalignant pain. Because a diagnostic blockade can give significant pain relief in a large variety of patients, it is worthwhile to investigate new methods that provide lasting neural blockade of the superior hypogastric plexus and long-lasting relief of this devastating condition.