Efficacy, Effectiveness, Safety, and Cost-effectiveness of Epidural Adhesiolysis for Treating Failed Back Surgery Syndrome. A Systematic Review

Brito-García, N; García-Pérez, Lidia; Kovacs, Francisco M.; Pino-Sedeño, Tasmania del; Pérez-Ramos, Jeanette; Imaz-Iglesia, Iñaki; Serrano‐Aguilar, Pedro

doi:10.1093/pm/pny233

Cited by 19 publications

(19 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Scar tissue in the injured areas stabilizes the adjacent tissues. Post-epidural fibrosis and the consequent firm adhesions to dura mater, however, may cause low back pain 1 and even hinder secondary surgeries. Numerous biological methods to reduce scar formation after spine surgery have been postulated by our team 2 – 4 and other labs 5 – 7 .…”

Section: Introductionmentioning

confidence: 99%

Neutrophil extracellular traps promote scar formation in post-epidural fibrosis

et al. 2020

View full text Add to dashboard Cite

Low back pain following spine surgery is a major complication due to excessive epidural fibrosis, which compresses the lumbar nerve. The mechanisms of epidural fibrosis remain largely elusive. In the drainage samples from patients after spine operation, neutrophil extracellular traps (NETs) and NETs inducer high-mobility group box 1 were significantly increased. In a mouse model of laminectomy, NETs developed in the wound area post epidural operation, accompanied with macrophage infiltration. In vitro, macrophages ingested NETs and thereby increased the elastase from NETs via the receptor for advanced glycation end product. Moreover, NETs boosted the expression of fibronectin in macrophages, which was dependent on elastase and could be partially blocked by DNase. NF-κB p65 and Smad pathways contributed to the increased expression fibronectin in NETs-treated macrophages. In the mouse spine operation model, post-epidural fibrosis was significantly mitigated with the administration of DNase I, which degraded DNA and cleaved NETs. Our study shed light on the roles and mechanisms of NETs in the scar formation post spine operation.

show abstract

Section: Introductionmentioning

confidence: 99%

Neutrophil extracellular traps promote scar formation in post-epidural fibrosis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Consequently, systematic reviews may vary, and a systematic review does not guarantee high methodological and reporting rigor as shown by Riado Minguez et al (53), Ross et al (54), and others (16,(55)(56)(57)(58). Multiple systematic reviews have been published assessing percutaneous adhesiolysis, an interventional procedure utilized for recalcitrant, resistant conditions involving spinal pain, specifically in spinal stenosis, post lumbar surgery syndrome, and recalcitrant degenerative disc disease including disc herniation (17,33,(60)(61)(62). These systematic reviews (17,30,(60)(61)(62) have been performed with inclusion of randomized controlled trials (RCTs) (63)(64)(65)(66)(67)(68)(69), specifically in failed back surgery, spinal stenosis, and disc herniation with discordant results.…”

mentioning

confidence: 99%

Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Manchikant

2019

Pain Phys

View full text Add to dashboard Cite

Background: Post lumbar surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis are often contemplated in managing post lumbar surgery syndrome. Multiple previous systematic reviews have reached discordant conclusions about the level of evidence for the effectiveness of percutaneous adhesiolysis in managing post lumbar surgery syndrome and other conditions. Study Design: A systematic review of previously published systematic reviews assessing efficacy of percutaneous adhesiolysis in managing post lumbar surgery syndrome. Objective: To evaluate the value and validity of previous systematic reviews performed after 2015 on effectiveness of percutaneous adhesiolysis in managing chronic refractory low back and lower extremity pain secondary to post lumbar surgery syndrome. Methods: Previous systematic reviews on percutaneous adhesiolysis were evaluated. The quality of each systematic review was assessed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews (AMSTAR). The randomized trials included in the available systematic reviews were assessed by Cochrane review criteria and Interventional Pain Management techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for methodologic quality. Data sources included relevant systematic reviews and the randomized trials included in those systematic reviews published since 2015 with searches of PubMed, Cochrane reviews, and Google Scholar through February 2019. Outcome Measures: Outcome measures were significant improvement defined as 50% pain relief and improvement in functional status. Short-term efficacy was defined as improvement of 6 months or less, whereas long-term efficacy was defined as more than 6 months. Results: Three systematic reviews and 4 randomized controlled trials (RCTs) of post lumbar surgery syndrome with chronic refractory low back and lower extremity pain showed notable evidence of significant pain relief. Only one systematic review, which was of low quality with inappropriate analysis, showed lack of evidence. Conclusion: Overall, the present analysis shows Level I evidence for percutaneous adhesiolysis based on significant evidence from published RCTs and 3 of the 4 systematic reviews. Key words: Post lumbar surgery syndrome, epidural fibrosis, percutaneous adhesiolysis, systematic reviews, randomized controlled trials

show abstract

“…In addition, cost-effectiveness is another issue with regards to epidural adhesiolysis in patients with lumbar PLS. For example, Brito-García pointed out the sub-par cost-effectiveness of adhesiolysis for lumbar PLS [22]. Although a direct comparison is not appropriate, we cautiously presume that combined epidural adhesiolysis and balloon decompression could be an effective alternative treatment option in terms of cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study

Shin

Kim

et al. 2020

JCM

View full text Add to dashboard Cite

Post-laminectomy syndrome (PLS) is characterized by chronic pain and complex pathological entity after back surgery. An epidural adhesiolysis is considered an effective treatment option for lumbar PLS. In this study, we retrospectively analyzed the outcome and evaluated the predictive factors of combined epidural adhesiolysis and balloon decompression using inflatable balloon catheters in lumbar PLS cases. One hundred and forty-seven subjects were retrospectively assessed and analyzed. The percentages of patients who exhibited treatment response were 32.0%, 24.5%, and 22.4% of the study population at 1, 3, and 6 months, respectively. In multivariate logistic regression analysis, the pain duration was independently associated with the treatment response six months after combined epidural adhesiolysis and balloon decompression (odds ratio = 0.985, 95% confidence interval = 0.971–0.999; p = 0.038). In addition, the receiver operating characteristic curve analysis showed that the area under the curve of pain duration after lumbar surgery was 0.680 (95% confidence interval = 0.597–0.754, p = 0.002), with an optimal cut-off value of ≤14 months, sensitivity of 51.5%, and specificity of 81.4% Our results suggest that an early intervention using combined epidural adhesiolysis and balloon decompression in lumbar PLS patients may be associated with a favorable outcome, even though it has limited effectiveness.

show abstract

Efficacy, Effectiveness, Safety, and Cost-effectiveness of Epidural Adhesiolysis for Treating Failed Back Surgery Syndrome. A Systematic Review

Cited by 19 publications

References 32 publications

Neutrophil extracellular traps promote scar formation in post-epidural fibrosis

Neutrophil extracellular traps promote scar formation in post-epidural fibrosis

Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study

Contact Info

Product

Resources

About