Evaluation of the efficacy of epiduroscopic adhesiolysis in Failed Back Surgery Syndrome

Ceylan, Ayşegül; Asik, Ibrahim; Özgencil, Güngör Enver; Erken, Burak

doi:10.3906/sag-1807-173

Cited by 9 publications

(18 citation statements)

References 24 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two articles were RCTs, 36,37 three were prospective‐, 38–40 and four were retrospective 41–44 observational studies. Together, they included 392 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Follow‐up data at 3 months were used as 6‐month data, and at 6 months as 12‐month data if no further data were available. Using the NOS for observational studies, four were rated as good, 39,41,43,44 one as moderate, 42 and two as poor 38,40 (Table 2b). Poor quality was rated because patients were excluded from follow‐up based on outcome or due to incomplete reporting of data.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis

et al. 2020

View full text Add to dashboard Cite

Introduction Low‐back or leg pain in patients suffering from failed back surgery syndrome (FBSS) is often severe, having a major impact on functionality and quality of life. Despite conservative and surgical treatments, pain can be persistent. An alternative treatment option is epiduroscopy, a minimally invasive procedure based on mechanical adhesiolysis of epidural fibrosis. As epidural fibrosis is speculated to be a major contributor in the pathophysiologic process of FBSS, this review evaluates the effectiveness of epiduroscopy in FBSS patients. Methods and materials A systematic literature search was performed in PubMed, Embase, and Cochrane databases. Critical appraisal was performed using validated tools. Meta‐analysis was performed using generic inverse variance analysis. Results From the 286 identified articles, nine studies were included. The visual analogue scale (VAS) average was 7.6 at baseline, 4.5 at 6, and 4.3 at 12 months. The Oswestry Disability Index (ODI) average was 61.7% at baseline, 42.8% at 6, and 46.9% at 12 months. An average of 49% of patients experienced significant pain relief at 6 and 37% at 12 months. Meta‐analysis showed a pooled VAS mean difference of 3.4 (2.6 to 4.1; 95% confidence interval [CI]) and 2.8 (1.6 to 4.0; 95% CI) and pooled ODI mean difference of 19.4% (12.5 to 26.4%; 95% CI) and 19.8% (13.8 to 25.9%; 95% CI) at 6 and 12 months, respectively. Conclusion Current literature demonstrates a clinically relevant reduction in pain and disability scores at 6 to 12 months after mechanical adhesiolysis in FBSS patients. The quality of evidence is moderate, and the level of recommendation is weak. Practitioners should consider the benefits of epiduroscopy after weighing the risks for individual patients with FBSS.

show abstract

“…Two articles were RCTs, 36,37 three were prospective‐, 38–40 and four were retrospective 41–44 observational studies. Together, they included 392 patients.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…According to previous studies, the clinical or surgical outcomes of SELD were found to be favorable in various lumbar spine diseases [ 3 – 7 , 12 – 17 ]. In particular, several recent papers regarding the clinical outcome of SELD for disc herniation have reported that the clinical outcome was favorable as there was significant improvement in low back pain or radiating leg pain, patient satisfaction rate of more than 70%, and low rates of surgical failure or recurrence [ 8 , 18 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

Son

Yoo

et al. 2021

BMC Surg

View full text Add to dashboard Cite

Background Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD. Results According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825–(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 min; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann–Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups. Conclusion The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

show abstract

“…After the United States Food and Drug Administration approval of epiduroscopy, the concept of SELD was developed, and the literatures reported the clinical outcomes of SELD in not only disc herniation but also in spinal stenosis, adhesion, chronic low back pain, failed back syndrome, and cystic lesions in the lumbosacral spine [7-15, 19, 20]. However, considering the principles of SELD, the distinctive difference from conventional procedures of drug injection or adhesiolysis like epidural neuroplasty is the effect of laser ablation on hydrated soft tissue [17][18][19][20][21]. In other words, whereas the function of drug delivery or adhesiolysis could create a transient effect as in other procedures, laser ablation of soft disc herniation could lead to the permanent effect of decompression [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

Son

Lee

Ahn

et al. 2020

Pain Research and Management

View full text Add to dashboard Cite

Objective. Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods. Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom’s criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results. Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p<0.001). According to Odom’s criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion. Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

show abstract

Evaluation of the efficacy of epiduroscopic adhesiolysis in Failed Back Surgery Syndrome

Cited by 9 publications

References 24 publications

Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis

Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

Contact Info

Product

Resources

About