Epidural Lysis of Adhesions

The Korean journal of pain 01/2014; 27(1):3-15. DOI: 10.3344/kjp.2014.27.1.3
Source: PubMed


As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

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    • "Our study may have shown favorable outcomes since we included patients with root compression confirmed by radiologic examinations and excluded patients who had recently undergone surgery. Third, several studies have sought to determine whether epidural administration of hyaluronidase or hypertonic saline improves outcomes[22,343536. Yousef et al.[34]compared treatment outcomes in 38 subjects who received either FL-guided caudal injections of 10 mL 0.25% bupivacaine + 30 mL 3% hypertonic saline + 80 mg methylprednisolone , or the same mixture with 1,500 units of hyaluronidase added. "
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    ABSTRACT: Objective: To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods: This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results: ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion: Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.
    Full-text · Article · Jan 2015 · Annals of Rehabilitation Medicine
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    Full-text · Article · Jul 2014 · The Korean journal of pain
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    ABSTRACT: The association between epidural fibrosis and recurrent symptoms after lumbar spine surgery remains a matter of debate in scientific literature and the underlying pathophysiological mechanism has not been clearly elucidated.
    No preview · Article · Sep 2014 · Pain physician
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