SELD, Trans Sacral Epiduroscopic Lumbar Decompression

Abstract

SELD (trans Sacral Epiduroscopic Lumbar Decompression) is one of the minimally invasive procedures for diagnosis in lumbar epidural space, an option for treating patients with lumbar stenosis, herniated disc, and spinal surgery syndrome using a flexible fiberoptic spinal endoscope. By inserting the epiduroscope through sacral hiatus, it is a way to reduce damage to normal structures of patient to a minimum.

Advances in optics science have made it possible to use 0.9 m diameter flexible spinal endoscopes with a resolution of 1.5 K for spinal surgery.

With this endoscope, which has a thin but clear field of vision, it is possible to identify lesions in the epidural cavity and observe the process of removing the lesion.

Good indications of SELD remain controversial, but it is a good modality for epidural decompression in lumbar stenosis, herniated lumbar disc, migrated disc herniation (Jeon et al., J Med Eng 229(10):693–702, 2015; Jinyoung and Daehyun, Medicine (Baltimore) 97(14): e0291, 2018), and for the removal of adhesion scar from chronic back pain after surgery. Epidural fibrosis and adhesions are the common postoperative complications related to the spinal operation. The formation of epidural scar tissue causes compression on the dura mater and traction of nerve roots, which may result in postoperative chronic back pain (Ding et al., Front. Pharmacol 16:774316, 2021). This procedure enables to cut perineural adhesion and fibrosis using catheter mechanically and chemically using drugs, and vaporization of fibrotic tissue using laser, which are good indications of epiduroscopic procedures.

This chapter will cover the process of the SELD procedure and what to pay attention to during the procedure. We hope that SELD could be one of the new modalities that reduce pain and improve the functional status in patients with low back pain (LBP) and radiculopathy caused by neural compression.