A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617]

Abstract

BackgroundPostoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described.MethodsA prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid.ResultsAmong the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status.ConclusionSpinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.

Taurine Reduced Epidural Fibrosis in Rat Models after Laminectomy via Downregulating EGR1

“…Interestingly, the decreased mRNA 'early growth response (EGR1)' was reported to be closely related to fibrosis in many previous studies [32][33][34][35]. Therefore, we thus leads to poor outcomes in spinal surgeries [1][2][3][4]. Previous reports have showed that epidural fibrosis was closely related to fibroblasts activation and collagen overproduction [27].…”

“…Epidural fibrosis has been demonstrated to contribute to up to 5% of poor surgical outcomes following decompressive surgery [4]. Given this, during the past decades, there has been an increasing interest in development of effective drugs to prevent the formation and adherence of the tissue to the neural elements is of importance in improving surgical outcomes.…”

Técnicas de epiduroscopia en el tratamiento del dolor lumbar: una revisión sistemática de la literatura

“…El estudio de mayor relevancia epidemiológica en este apartado fue el publicado por Manchikanti y cols. (8), en el cual se evaluó la efectividad de la lisis de adherencias por vía endoscópica en dolor lumbar crónico en un estudio clínico controlado aleatorizado. Cabe mencionar que aunque este estudio no utilizó un control con placebo, sí se trató de un estudio aleatorizado, doble ciego, con control por equivalencia, utilizando un diseño de controles activos.…”

“…De igual manera, cuando el dolor es de características radiculares, los resultados a largo plazo son más favorables que cuando se trata de dolor axial o inespecífico (15). Por otro lado, consideramos que a todo paciente que se realice epiduroscopia con fines terapéuticos se debe realizar lisis de adherencias y aplicación dirigida de esteroides (recomendación 1-B, nivel de evidencia II-1) (8). Se debe aclarar, sin embargo, que el método mediante el cual se realice la lisis de adherencias no tiene impacto en los resultados (recomendación 2-C, nivel de evidencia II-1) (10,13 (20) en los pacientes en quienes se tornan sintomáticas el tratamiento con epiduroscopia se ha convertido en una herramienta importante en el armamentario terapéutico del cirujano.…”

A comparison of non-endoscopic and endoscopic adhesiolysis of epidural fibrosis

“…Most often steroids and local anesthetics are injected into the epidural space after adhesiolysis [12,13,20] while other substances such as clonidine [12], hyaluronidase [14,19], ciprofloxacin [14] and ozone [14] have also been used.…”