Background: Percutaneous epidural adhesiolysis and spinal endoscopic adhesiolysis are interventional pain management techniques used to treat patients with refractory low back pain due
to epidural scarring. Standard epidural steroid injections are often ineffective, especially in patients with prior back surgery. Adhesions in the epidural space can prevent the flow of medicine
to the target area; lysis of these adhesions can improve the delivery of medication to the affected areas, potentially improving the therapeutic efficacy of the injected medications.
Study Design: A systematic review utilizing the methodologic quality criteria of the Cochrane
Musculoskeletal Review Group for randomized trials and the criteria established by the Agency for
Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials.
Objective: To evaluate and update the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis in managing chronic low back and lower extremity pain due to
radiculopathy, with or without prior lumbar surgery, since the 2005 systematic review.
Methods: Basic search identified the relevant literature, in the MEDLINE, EMBASE, and BioMed
databases (November 2004 to September 2006). Manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years were reviewed. Randomized and non-randomized studies are included in the review based on criteria established. Percutaneous adhesiolysis and endoscopic adhesiolysis are analyzed separately.
Outcome Measures: The primary outcome measure was significant pain relief (50% or greater). Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term relief was defined as less than 3 months, and long-term relief was defined as 3 months or longer.
Results: Studies regarding the treatment of epidural adhesions for the treatment of low back
and lower extremity pain were sought and reviewed. The evidence from the previous systematic review was combined with new studies since November 2004. There is strong evidence for
short term and moderate evidence for long term effectiveness of percutaneous adhesiolysis and
spinal endoscopy.
Conclusion: Percutaneous adhesiolysis and spinal endoscopy may be effective interventions to
treat low back and lower extremity pain caused by epidural adhesions.
Key Words: Spinal pain, chronic low back pain, percutaneous adhesiolysis, spinal endoscopic
adhesiolysis, spinal stenosis, post lumbar laminectomy syndrome, epidural fibrosis, epidural adhesions, caudal neuroplasty.
Revision Surgery for Short Segment Fusion Influences Postoperative Low Back Pain and Lower Extremity Pain: A Retrospective Single-Center Study of Patient-Based Evaluation