Non-endoscopic and endoscopic adhesiolysis in post-lumbar laminectomy syndrome: a one-year outcome study and cost effectiveness analysis.

Post lumbar laminectomy syndrome with its resultant chronic low back pain is estimated to occur in 20% to 50% of the patients. Among various procedures available, lysis of epidural adhesions is considered as one of the effective therapeutic modalities of management in these patients, and may be performed either non-endoscopically or endoscopically. This retrospective evaluation included 120 post lumbar laminectomy patients who underwent either non-endoscopic adhesiolysis (Group I) or endoscopic adhesiolysis (Group II) with 60 consecutive patients in each group. The quality of pain relief when greater than 50% was considered significant. Results showed all patients experienced significant relief following both procedures even though the number of patients experiencing significant relief decreased with both techniques over a time period. Overall relief with the first procedure (mean + SEM) was 12 + 3.2 weeks for Group I, and it was 20 + 2.9 weeks for Group II with significantly longer improvement in Group II than Group I. At one year follow up, the results showed that with repeat procedures, 72% in Group I and 40% in Group II experienced significant relief at 6 months, whereas at 12 months, it decreased to 52% in Group I and 22% in Group II, with a significantly greater number of patients experiencing relief at 6 months and 12 months in Group I, than Group II, even though Group I patients underwent a greater number of procedures. Cost effectiveness analysis showed Group I patients experiencing significant relief at a cost of $40 per week, with one year quality of life improvement for $2,080, whereas it was $135 per week improvement in Group II with a one year quality of life improvement at a cost of $7,020 with significant difference noted in cost effectiveness. In conclusion, non-endoscopic epidural adhesiolysis and administration of corticosteroids and hypertonic saline is a safe and cost effective procedure for relieving chronic intractable pain in post lumbar laminectomy patients who failed to respond to other modalities of treatment. Similarly, endoscopic adhesiolysis with the administration of corticosteroids is also a safe and possibly cost-effective technique for relief of chronic intractable pain failing to respond to other modalities of treatments.