Laxmaiah Manchikanti1,2,3,4, Nebojsa Nick Knezevic5,6, Satya P Sanapati7,8, Mahendra R Sanapati9, Alan D Kaye10,11, Joshua A Hirsch12. 1. Pain Management Centers of America, 1101 Professional Blvd Ste 100, Evansville, IN, 47714, USA. drlm@thepainmd.com. 2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA. drlm@thepainmd.com. 3. Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, 1542 Tulane Ave Room 659, New Orleans, LA, 70112, USA. drlm@thepainmd.com. 4. , Paducah, KY, USA. drlm@thepainmd.com. 5. Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL, 60657, USA. 6. Departments of Anesthesiology and Surgery, College of Medicine, University of Illinois, Chicago, IL, USA. 7. St Louis University, St. Louis, MO, USA. 8. Millennium Pain Center, Bloomington, IL, USA. 9. Pain Management Centers of America, 1101 Professional Blvd Ste 100, Evansville, IN, 47714, USA. 10. Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, 1542 Tulane Ave Room 659, New Orleans, LA, 70112, USA. 11. Department of Pharmacology, LSU Health Science Center, New Orleans, LA, USA. 12. Neurointerventional Radiology, Neurointerventional Spine, Massachusetts General Hospital and Harvard Medical School, 55 Blossom Street, Gray 241B, Boston, MA, 02114, USA.
Abstract
PURPOSE OF REVIEW: The growing prevalence of spinal pain in the USA continues to produce substantial economic impact and strain on health-related quality of life. Percutaneous adhesiolysis is utilized for recalcitrant, resistant conditions involving spinal pain when epidural injections have failed to provide adequate improvement, especially low back and lower extremity pain, specifically in post-lumbar surgery syndrome. Despite multiple publications and systematic reviews, the debate continues in reference to effectiveness, safety, appropriate utilization, and medical necessity of percutaneous adhesiolysis in chronic pain. This systematic review, therefore, was undertaken to evaluate and to update effectiveness of percutaneous adhesiolysis to treat chronic refractory low back and lower extremity pain, post-surgical patients of the lumbar spine. RECENT FINDINGS: From 2009 to 2016, there was a decline of 53.2% utilization of percutaneous adhesiolysis with an annual decline of 10.3% per 100,000 fee-for-service (FFS) Medicare population. Multiple insurers, including Medicare, with Medicare area contractors of Noridian and Palmetto have issued noncoverage policies for percutaneous adhesiolysis resulting in these steep declines and continued noncoverage by Medicare Advantage plans, Managed Care plans of Medicaid, and other insurers. Since 2005, 4 systematic reviews of percutaneous adhesiolysis were published with 3 of them showing proper methodology and appropriate results with effectiveness of adhesiolysis, whereas one poorly performed systematic review showed negative results. In addition, there were only 4 randomized controlled trials (RCTs) to be included in the previous systematic reviews of post-surgery syndrome, whereas now, the RCTs and other studies have increased. This systematic review shows level I or strong evidence for the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain related to post-lumbar surgery syndrome.
PURPOSE OF REVIEW: The growing prevalence of spinal pain in the USA continues to produce substantial economic impact and strain on health-related quality of life. Percutaneous adhesiolysis is utilized for recalcitrant, resistant conditions involving spinal pain when epidural injections have failed to provide adequate improvement, especially low back and lower extremity pain, specifically in post-lumbar surgery syndrome. Despite multiple publications and systematic reviews, the debate continues in reference to effectiveness, safety, appropriate utilization, and medical necessity of percutaneous adhesiolysis in chronic pain. This systematic review, therefore, was undertaken to evaluate and to update effectiveness of percutaneous adhesiolysis to treat chronic refractory low back and lower extremity pain, post-surgical patients of the lumbar spine. RECENT FINDINGS: From 2009 to 2016, there was a decline of 53.2% utilization of percutaneous adhesiolysis with an annual decline of 10.3% per 100,000 fee-for-service (FFS) Medicare population. Multiple insurers, including Medicare, with Medicare area contractors of Noridian and Palmetto have issued noncoverage policies for percutaneous adhesiolysis resulting in these steep declines and continued noncoverage by Medicare Advantage plans, Managed Care plans of Medicaid, and other insurers. Since 2005, 4 systematic reviews of percutaneous adhesiolysis were published with 3 of them showing proper methodology and appropriate results with effectiveness of adhesiolysis, whereas one poorly performed systematic review showed negative results. In addition, there were only 4 randomized controlled trials (RCTs) to be included in the previous systematic reviews of post-surgery syndrome, whereas now, the RCTs and other studies have increased. This systematic review shows level I or strong evidence for the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain related to post-lumbar surgery syndrome.
Entities:
Keywords:
Adhesiolysis; Chronic low back pain; Epidural scarring; Post-lumbar surgery syndrome; Radicular pain
Authors: Rajesh N Janapala; Laxmaiah Manchikanti; Mahendra R Sanapati; Srinivasa Thota; Alaa Abd-Elsayed; Alan D Kaye; Joshua A Hirsch Journal: J Pain Res Date: 2021-09-10 Impact factor: 3.133
Authors: Laxmaiah Manchikanti; Emilija Knezevic; Nebojsa Nick Knezevic; Mahendra R Sanapati; Alan D Kaye; Srinivasa Thota; Joshua A Hirsch Journal: Korean J Pain Date: 2021-07-01