What is the role of epidural adhesiolysis in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Percutaneous adhesiolysis with or without spinal endoscopy is another interventional technique used to manage cLBP. [177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190] This procedure is performed to disrupt presumed epidural adhesions, which may affect nerves or other pain-sensitive tissues. Percutaneous lysis of epidural adhesions may also enable the improved delivery of injected drugs to targeted painful structures. Epidural adhesiolysis with direct deposition of corticosteroids in the spinal canal can be achieved with a 3-D view generated using an epidural endoscope.

Two randomized trials were positive for both short- and long-term relief. [189, 191] The effectiveness of spinal endoscopic adhesiolysis was summarized in an evidence synthesis by Manchikanti et al [137] with a review and comparison of 2 prospective [192, 193] and 4 retrospective studies [177, 189, 190, 191] . In a synthesis of the evidence related to the clinical use of percutaneous epidural adhesiolysis using a spring-guided catheter with or without hypertonic saline, whereby short-term relief was defined as less than 3 months and long-term relief as lasting longer than 3 months.

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