Is Percutaneous Adhesiolysis Effective in Managing Chronic Low Back and Lower Extremity Pain in Post-surgery Syndrome: a Systematic Review and Meta-analysis

Manchikanti, Laxmaiah; Knezevic, Nebojsa Nick; Sanapati, Satya P; Sanapati, Mahendra R; Kaye, Alan D.; Hirsch, Joshua A

doi:10.1007/s11916-020-00862-y

Cited by 16 publications

(20 citation statements)

References 69 publications

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“…In fact, Manchikanti et al [10] performed a comparative systematic review and metaanalysis of the study by Chou et al [51], which showed significantly different results when the analysis was performed utilizing methodology that did not convert activecontrolled trials to placebo-controlled trials. Similar issues were also raised with findings of systematic reviews in assessing multiple interventional techniques, including the effectiveness of percutaneous adhesiolysis in postlumbar surgery syndrome [13,15,16,52].…”

Section: Discussionmentioning

confidence: 73%

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

et al. 2021

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Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions: Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

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Section: Discussionmentioning

confidence: 73%

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

et al. 2021

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“…However, contrary to these claims, significant demonstration of evidence for all interventional techniques, along with percutaneous adhesiolysis with randomized controlled trials (RCTs), systematic reviews, cost utility analysis, and evidence for real world scenarios has been demonstrated (9,. Specifically, the evidence is significant for percutaneous adhesiolysis in managing chronic recalcitrant low back pain Declining Utilization of Percutaneous Adhesiolysis in the FFS Medicare Population secondary to post-surgery syndrome, spinal stenosis, and disc herniation (63)(64)(65)(66)(67)(68)(73)(74)(75)(76). Even then, percutaneous adhesiolysis continues to face an irreversible decline due to multiple policies, essentially not based on evidence.…”

Section: Discussionmentioning

confidence: 99%

Declining Utilization Patterns of Percutaneous Adhesiolysis Procedures in the Fee-For-Service (FFS) Medicare Population

et al. 2020

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BACKGROUND: Percutaneous epidural adhesiolysis is a minimally invasive therapeutic modality used in the treatment of patients with chronic low back and lower extremity pain, often recalcitrant to other modalities including epidural injections and surgical interventions. While the initial utilization since its introduction and development of appropriate Current Procedural Terminology (CPT) codes increased up until 2008, but since 2009, there has been a significant decline in utilization of these procedures in the Medicare population. These procedures declined by 53.2% at an annual rate of 10.3% from 2009 to 2016. A recent update analysis on the reversal and decline of growth of utilization of interventional techniques in managing chronic pain in the Medicare population from 2009 to 2018 revealed an even further decline of adhesiolysis procedures. STUDY DESIGN: An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain in the Medicare population from 2000 to 2018, with comparative analysis from 2000 to 2009 and 2009 to 2018. OBJECTIVE: To assess the utilization patterns of percutaneous adhesiolysis in managing chronic low back pain in the Medicare population. METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2018 was used. In this analysis, various variables were assessed in reference to usage patterns of percutaneous adhesiolysis procedures with analysis of growth or declining utilization patterns. We also assessed specialty-based utilization, as well as statewide utilization. RESULTS: The decline of percutaneous adhesiolysis procedures began in 2009 and has continued since then. From 2009 to 2018, the overall decline was 69.2%, with an annual decline of 12.3% compared to an overall 62.6% increase from 2000 to 2009, with an annual increase of 5.6%. Compared to multiple other interventions, including epidural injections and facet joint interventions, percutaneous adhesiolysis has declined at a rapid rate. CONCLUSIONS: This assessment in the FFS Medicare population in the United States shows an irreversible decline of utilization of percutaneous adhesiolysis procedures, which has been gradually deteriorating with a 69.2% decline from 2009 to 2018 with an annual decline of 12.3% during that same time period. KEY WORDS: Epidural injections, percutaneous adhesiolysis, post-surgery syndrome, spinal stenosis, lumbar disc herniation

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“…Combined significant weakness (motor power grade ≤ 3/5) or cauda equina syndrome, segmental instability (angular motion ≥ 15° and/or translation ≥ 4 mm) Trauma-associated LDH Combined neurological disease (such as Parkinson disease), inflammatory joint disease, tumor, infection, and neuropathy Previous history of spinal surgery Pregnancy treatment decisions followed the same principles. After a review of previous treatments, a combination of noninvasive interventions such as lifestyle modifications, exercise, physiotherapy, and/or medication (nonsteroidal anti-inflammatory drugs and/or weak opioids) was applied for several weeks to relieve patients' symptoms 1,2 . If these noninvasive treatments were not effective, other nonsurgical treatments, such as manual manipulation, therapeutic massage, and injection-based treatments, were performed for another several weeks 1,2 .…”

Section: Exclusion Criteriamentioning

confidence: 99%

“…After a review of previous treatments, a combination of noninvasive interventions such as lifestyle modifications, exercise, physiotherapy, and/or medication (nonsteroidal anti-inflammatory drugs and/or weak opioids) was applied for several weeks to relieve patients' symptoms 1,2 . If these noninvasive treatments were not effective, other nonsurgical treatments, such as manual manipulation, therapeutic massage, and injection-based treatments, were performed for another several weeks 1,2 . If these treatments were not effective, percutaneous adhesiolysis was recommended 2 .…”

Section: Exclusion Criteriamentioning

confidence: 99%

Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study

Kim

Choi

Chung

et al. 2021

Sci Rep

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Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

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Is Percutaneous Adhesiolysis Effective in Managing Chronic Low Back and Lower Extremity Pain in Post-surgery Syndrome: a Systematic Review and Meta-analysis

Cited by 16 publications

References 69 publications

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

Declining Utilization Patterns of Percutaneous Adhesiolysis Procedures in the Fee-For-Service (FFS) Medicare Population

Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study

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