Chronic spinal pain is the leading cause of disability worldwide. More than 50 million Americans live with low back or neck pain severe enough to limit daily function. Eight hundred thousand lumbar surgeries are performed in the United States every year. And yet by a conservative estimate, 40% of patients who undergo lumbar spinal surgery will develop what clinicians call Failed Back Surgery Syndrome — persistent or recurrent pain that surgery did not resolve, and that the current toolkit has no reliable way to address.

That number — 40% — is not a reflection of surgical failure in the narrow sense. In many of these patients, the surgery accomplished exactly what it was designed to do: it decompressed the stenotic segment, removed the herniated disc, stabilized the unstable level. What the surgery could not do was see, characterize, or treat the anterior epidural fibrosis that formed in the surgical wake. Invisible to CT. Invisible to MRI. Invisible to every guidance modality currently available in the operating room or procedure suite.

At VerAvanti, this is the problem we are built to solve. Not a part of it — the structural, upstream, visualization deficit that sits beneath an enormous category of treatment failure across multiple spinal pain indications.

The instrument problem that medicine has been working around

Interventional spine care is technically sophisticated. The devices are advanced. The clinicians are skilled. The procedures — epiduroscopic laser neural decompression, spinal cord stimulation lead placement, medial branch radiofrequency ablation — are well-designed, evidence-supported interventions that work for most patients most of the time.

What they have in common is that they are performed without direct visualization of the target tissue. Fluoroscopy shows bone. It does not show the epidural fibrosis compressing the nerve root. It does not show whether the SCS lead is resting in dorsal epidural fat or embedded in scar from a prior surgery. It does not show whether the RFA electrode is 1 mm from the medial branch nerve or 4 mm away in fat.

Clinicians have developed landmark protocols, tactile feedback techniques, and imaging adjuncts to work around this fundamental visibility gap. Those protocols are good. They are also, by definition, approximations — and the outcome variance in every one of these procedures reflects the gap between approximation and direct tissue confirmation.

The problem is not that spinal pain procedures fail. It is that they succeed by approximation when the technology exists to make them succeed by confirmation.

What the SFE platform does that no current device can

The Scanning Fiber Endoscope — the SFE — is a single-fiber forward-looking endoscope built around three capabilities that, together, have no equivalent in any existing interventional spine tool:

• Forward-looking visualization from a single scanning fiber — the thinnest possible catheter profile, with a lens that sees the approach path before the tip reaches it. In a 2 mm cervical epidural space. In a fibrosis-narrowed lumbar canal. In the dorsal epidural corridor being prepared for an SCS lead.

• Optical coherence tomography (OCT) at 15–25 µm axial resolution with approximately 3 mm tissue penetration depth — providing real-time cross-sectional tissue microstructure at the target site. Epidural fibrosis has a characteristic OCT signature. So does dorsal epidural fat. So does the dural surface. So does the medial branch nerve sheath. OCT converts a tissue-type guess into a tissue-type confirmation.

• Multimodal fluorescence imaging that differentiates actively inflammatory tissue from mature avascular scar — a distinction that governs laser parameter selection in ELND, identifies prior lead tracks in SCS revision cases, and characterizes the ablation completeness in ERFA — without contrast injection, at the point of therapeutic decision.

These three capabilities are co-deployed through a single thin catheter with Ho:YAG laser co-delivery. One device. One procedural pass. The full picture.

The four problems VerAvanti is solving — and the four blogs that go deeper

The SFE platform addresses four distinct spinal pain indications, each representing a different facet of the same underlying visibility problem. We have written an extended clinical blog for each:

• Lumbar ELND — The Core Indication — How forward-looking visualization and OCT tissue characterization change outcomes in the highest-volume epiduroscopic application. The evidence base, the anatomy, and the ceiling that better instrumentation can move.

• Cervical ELND — The Anatomy Problem — Why a 2 mm epidural corridor adjacent to the spinal cord demands forward-looking visualization, and why every existing epiduroscope fails that demand. The structural case for extending ELND to the cervical spine.

• SCS Lead Placement — The Guidance Gap — Fluoroscopy shows bone. A 15–40% lead revision rate reflects what it cannot show. How epiduroscopic visualization and OCT tissue characterization change the soft-tissue problem at the center of SCS lead malposition.

• Endoscopic RFA — The Unmeasured Variable — Electrode-to-nerve distance predicts RFA success and cannot currently be measured intraoperatively. How OCT-guided ERFA converts medial branch targeting from probabilistic approximation to direct tissue confirmation.

Why VerAvanti — and why now

The clinical need for forward-looking epiduroscopic visualization has been recognized in the spine literature for more than a decade. What has prevented any device from addressing it is the engineering constraint: forward-looking endoscopy at the scale required for epiduroscopic access demands a single-fiber scanning architecture that until recently was not manufacturable at the required specifications.

The scanning fiber endoscope technology that underlies the SFE platform resolves that constraint. It enables a forward-looking, OCT-capable, fluorescence-enabled device at the catheter profile the epidural space actually requires. The clinical opportunity has been waiting for the engineering solution to catch up. We believe it has.

The SFE is in active development. Our Spinal Cord Pain Management KOL recruitment program is on. Lumbar and Cervical ELND, SCS lead guidance, and endoscopic RFA follow as the platform expands. If you are a clinician working in any of these areas, or an institutional partner interested in where spinal pain care is going, we would welcome the conversation.