Medical Policy

This document addresses epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, an endoscopic procedure where the epidural space is explored for the diagnosis and treatment of radicular spinal pain.

Note: Mechanical or laser lysis, which may be performed with epiduroscopy, is addressed in a related document. Please see the following for additional information:

• SURG.00072 Lysis of Epidural Adhesions

Investigational and Not Medically Necessary:

Epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, is considered investigational and not medically necessary.

Summary

Epiduroscopy, also referred to as epidural spinal endoscopy or epidural myeloscopy, is a minimally invasive technique that allows direct visualization of the epidural space for diagnostic purposes or to guide certain spinal interventions. Although some studies report reductions in pain and improved functional outcomes, The available evidence is limited by lack of robust study samples, lack of controls, and inconsistent methodology. Randomized data have not demonstrated clear advantages over conventional management approaches or adequately addressed questions regarding safety concerns. As a result, the clinical utility of epiduroscopy remains uncertain and further well-designed trials are needed to establish its role in the management of spinal pain.

Discussion

Bosscher and Heavner (2012) published a study evaluating epiduroscopy used as a diagnostic procedure. The investigators used spinal canal endoscopy to study the spinal segment(s) where pain was elicited via endoscopic evaluation compared to the vertebral level from where the pain was thought to originate, as determined by clinical evaluation and by magnetic resonance imaging (MRI). A total of 143 individuals who underwent spinal canal endoscopy (epiduroscopy) were asked whether pain generated by pressure upon epidural structures with the tip of an endoscope was similar in character and distribution (concordant) to the pain for which the individuals sought treatment. The most common level was at L4 to L5. The least common level was L5 to S1. No painful location was identified by epiduroscopy in 18 participants, with 8 of these having positive MRI findings. In 40 participants, the level determined by clinical evaluation correlated with the level at which pain could be reproduced during epiduroscopy. In 28 participants, the MRI indicated a specific vertebral level that corresponded to the level at which pain could be reproduced with epiduroscopy. The authors concluded that epiduroscopy is more reliable than either clinical evaluation or MRI for determining the vertebral level where clinically significant spinal pathology occurs. Although the study incorporated a diverse sample by age and gender, it was non-randomized which could lead to potential confounding and selection bias. Additionally, no data on adverse events or long-term outcomes was provided.

Dashfield and colleagues (2005) published the results of a randomized controlled trial (RCT) evaluating epiduroscopy to guide interventional therapy for 60 participants with sciatica undergoing steroid injection treatment. No significant differences in outcomes were identified between the group that received epiduroscopy guidance and the group that did not. All epiduroscopy group participants experienced transient low back discomfort, but no procedure-related adverse events were reported.

There are published case series evaluating epiduroscopy for guiding intervention (Hazer, 2018; Ruetten, 2003). In 2018, Hazer and colleagues retrospectively reviewed 88 individuals with low back pain and radicular pain who received epiduroscopy. Compared with baseline, after epiduroscopy, there were significant decreases in pain as measured by a visual analogue scale (VAS) and the Oswestry Disability Index (ODI), p<0.001 for each. No procedure-related adverse events were reported. The study was limited by the lack of a control or comparison group.

Gill and colleagues (2005) reported on a literature review of 12 cases of visual impairment as a complication of epiduroscopy, a rare but significant complication of the procedure. In all cases a bolus injection of fluid resulted in a sudden increase in cerebrospinal fluid pressure and compression of the optic nerve. The study characterized the complication and offered possible mechanisms for its cause, implicating an increase in epidural pressure being transmitted into the subarachnoid space to the optic nerve sheath resulting in optic nerve and vascular compression. No solutions or suggestions for treatment options were discussed.

Epiduroscopy, also known as epidural spinal endoscopy or epidural myeloscopy, is a procedure in which a steerable or controllable flexible endoscope is used to visually examine the epidural anatomic structures. The procedure is mainly used for the visualization of the epidural space to identify epidural adhesions, fibrosis, and scars. In addition, epiduroscopy can be used for visualization during interventions such as mechanical or laser lysis of spinal adhesions, or introduction of steroids to areas of inflamed tissues. The Myelotec Myeloscope (Myelotec, Inc. Roswell, GA) device received premarket notification by the U.S. Food and Drug Administration (FDA) in September 1996. The KSEA Epiduroscope (Karl Storz Endoscopy - America, Inc., Culver City, CA) also received premarket notification by the FDA in June 1999.

Endoscope: A highly flexible fiberoptic instrument which allows the user to see the inside of the body for diagnostic procedures and allows for therapeutic functions through special channels built into the scope that allow passage of specialized tools to the treatment area.

Endoscopy: The visual inspection of any cavity of the body by means of an endoscope.

Radiculopathy: Any disease of the spinal nerve roots and spinal nerves; radiculopathy is characterized by pain which seems to radiate from the spine to extend outward to cause symptoms away from the source of the spinal nerve root irritation; causes of radiculopathy include deformities of the discs between the building blocks of the spine (the vertebrae).

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Investigational and Not Medically Necessary:
When the code describes a procedure indicated in the Position Statement as investigational and not medically necessary.

Peer Reviewed Publications:

1. Bosscher HA, Heavner JE. Diagnosis of the vertebral level from which low back or leg pain originates. A comparison of clinical evaluation, MRI and epiduroscopy. Pain Pract. 2012; 12(7):506-512.
2. Dashfield AK, Taylor MB, Cleaver JS, Farrow D. Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial. Br J Anaesth. 2005; 94(4):514-519.
3. Gill JB, Heavner JE. Visual impairment following epidural fluid injections and epiduroscopy: a review. Pain Med. 2005; 6(5):367-374.
4. Hazer DB, Acarbaş A, Rosberg HE. The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients. Korean J Pain. 2018; 31(2):109-115.
5. Ruetten S, Meyer O, Godolias G. Endoscopic surgery of the lumbar epidural space (epiduroscopy): results of therapeutic intervention in 93 patients. Minim Invasive Neurosurg. 2003; 46(1):1-4.

Government Agency, Medical Society, and Other Authoritative Publications:

1. U.S. Food and Drug Administration (FDA) 510(k) Premarket Notification Database. Summary of Safety and Effectiveness. Myelotec Myeloscope. No. K960194. Rockville, MD: FDA. September 4, 1996. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf/K960194.pdf. Accessed on September 22, 2025.
2. U.S. Food and Drug Administration (FDA) 510(k) Premarket Notification Database. Summary of Safety and Effectiveness. KSEA Epiduroscope. No. K991051. Rockville, MD: FDA. June 1, 1999. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf/K991051.pdf. Accessed on September 22, 2025.

Epidural Myeloscopy
Epidural Spinal Endoscopy
Epiduroscopy
KSEA Epiduroscope

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