Epidural Lysis of Adhesions for Failed Back Surgery and Spinal Stenosis

Hsu, Eugene; Atanelov, Levan; Plunkett, Anthony; Chai, Nu Cindy; Chen, Yi‐An; Cohen, Steven P.

doi:10.1213/ane.0000000000000042

Cited by 32 publications

(16 citation statements)

References 25 publications

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“…A large retrospective, epidemiological study conducted in patients with radicular pain evaluated at Mayo Clinic found that although recurrence was frequent (31.7%), at the mean follow-up of 5.9 years, 90.5% of patients experienced either no or only mild pain. 28 The finding that higher pain scores and radicular symptoms are associated with chronicity and poor outcome for neck pain is similar to what occurs with low back pain [29][30][31][32] and suggests that both subjective and objective factors play a role in prognosis.…”

Section: Natural Course Of Neck Painmentioning

confidence: 85%

Epidemiology, Diagnosis, and Treatment of Neck Pain

Cohen

2015

Mayo Clinic Proceedings

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Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.

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Section: Natural Course Of Neck Painmentioning

confidence: 85%

Epidemiology, Diagnosis, and Treatment of Neck Pain

Cohen

2015

Mayo Clinic Proceedings

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471

303

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“…Yet, few studies have examined the factors associated with outcomes of epidural LOA. In a large retrospective analysis by Hsu et al conducted in 115 patients who underwent epidural LOA, the one variable that was most consistently associated with successful response in both univariate and multivariate analysis was age greater than 81 years [62]. A numeric rating score (NRS) <9 was also associated with a positive outcome.…”

Section: Factors Associated With Treatment Outcomementioning

confidence: 99%

“…However, in two other studies [42,43], the injectate volume was kept constant and a significant difference between catheter adhesiolysis and a control, high-volume ESI was reported, suggesting a benefit related to either the use of a catheter, hypertonic saline or both interventions. The beneficial effect volume confers is likely constrained by a ceiling effect, as Hsu et al found no differences in mean volumes injected in those subjects who experienced a positive results (mean 20.8 ml) and those with a negative outcome (20.2 ml) (Table 2) [62]. …”

Section: Factors Associated With Treatment Outcomementioning

confidence: 99%

Epidural Lysis of Adhesions

et al. 2014

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As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

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“…Hsu et al 26 retrospectively studied 115 patients who underwent epidural lysis of adhesions for FBSS or spinal stenosis and reported a modest success rate. Thereafter, Ko et al 27 found that recurrence of pain within 2-4 weeks after selective nerve root block can be reduced when hyaluronidase is added to the routine block regimen.…”

Section: Resultsmentioning

confidence: 99%