3 The procedure
3.1 Epiduroscopic lumbar discectomy through the sacral hiatus for sciatica is usually done with the patient under sedation and local anaesthesia. Under fluoroscopic guidance, a needle is inserted through the sacral hiatus. Over a guidewire a dilator is used to create a working channel through which a flexible endoscope can be steered into the anterior epidural space. The endoscope can reach nerve roots as high as the mid-lumbar spine bilaterally. When the appropriate disc level is reached, a laser optic fibre is introduced through the working channel of the endoscope to ablate disc tissue. The aim is to relieve pain by removing parts of the disc that press against the spinal nerve.