Paulo Pereira1,2,3, Milton Severo4,5, Pedro Monteiro1,2, Pedro Alberto Silva1,2, Virgínia Rebelo6, José Manuel Castro-Lopes7, Rui Vaz1,2,3. 1. Department of Neurosurgery, São João Hospital Center, Porto, Portugal. 2. Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal. 3. Unit of Neurosciences, Hospital CUF-Porto, Porto, Portugal. 4. Institute of Public Health, University of Porto, Porto, Portugal. 5. Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal. 6. Department of Psychiatry and Mental Health, São João Hospital Center, Porto, Portugal. 7. Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.
Abstract
OBJECTIVE: To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in patients with postoperative fibrosis and persistent or recurrent symptoms. STUDY DESIGN: Prospective study. METHODS: Patients with persistent or recurrent low back and/or lower limb pain after lumbar spine surgery, in whom no relevant findings were present on MR images besides epidural scar tissue, were submitted to epiduroscopic adhesiolysis. Patient-reported outcomes including pain and disability were assessed in predefined time intervals and compared to baseline. RESULTS: Twenty-four patients were enrolled. It was possible to elicit the patient's usual pain by probing the epidural scar tissue in all patients. Statistically significant improvement in low back and lower limb pain was observed in all assessment periods up to 12 months. A pain relief over 50% was achieved in 71% of the patients at 1 month, 63% at 3 and 6 months, and 38% at 12 months. Disability scores significantly improved for around 6 months. Mean patient satisfaction rates were 80% at 1 month, 75% at 3 months, 70% at 6 months, and 67% 1 year after intervention. Only 1 transient postprocedural complication was detected. CONCLUSION: Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.
OBJECTIVE: To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in patients with postoperative fibrosis and persistent or recurrent symptoms. STUDY DESIGN: Prospective study. METHODS:Patients with persistent or recurrent low back and/or lower limb pain after lumbar spine surgery, in whom no relevant findings were present on MR images besides epidural scar tissue, were submitted to epiduroscopic adhesiolysis. Patient-reported outcomes including pain and disability were assessed in predefined time intervals and compared to baseline. RESULTS: Twenty-four patients were enrolled. It was possible to elicit the patient's usual pain by probing the epidural scar tissue in all patients. Statistically significant improvement in low back and lower limb pain was observed in all assessment periods up to 12 months. A pain relief over 50% was achieved in 71% of the patients at 1 month, 63% at 3 and 6 months, and 38% at 12 months. Disability scores significantly improved for around 6 months. Mean patient satisfaction rates were 80% at 1 month, 75% at 3 months, 70% at 6 months, and 67% 1 year after intervention. Only 1 transient postprocedural complication was detected. CONCLUSION: Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.
Authors: Ivan Urits; Ruben H Schwartz; Joseph Brinkman; Lukas Foster; Paulo Miro; Amnon A Berger; Hisham Kassem; Alan D Kaye; Laxmaiah Manchikanti; Omar Viswanath Journal: Psychopharmacol Bull Date: 2020-10-15
Authors: Kai-Uwe Lewandrowski; Ivo Abraham; Jorge Felipe Ramírez León; Albert E Telfeian; Morgan P Lorio; Stefan Hellinger; Martin Knight; Paulo Sérgio Teixeira De Carvalho; Max Rogério Freitas Ramos; Álvaro Dowling; Manuel Rodriguez Garcia; Fauziyya Muhammad; Namath Hussain; Vicky Yamamoto; Babak Kateb; Anthony Yeung Journal: J Pers Med Date: 2022-06-29