What is the efficacy of epidural adhesiolysis in the treatment of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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The effectiveness of spinal endoscopic adhesiolysis was further evaluated by reviewing 2 prospective [192, 193] and 2 retrospective studies [177, 194] . In his follow-up study, Manchikanti defined short-term relief as less than 6 months and long-term relief as more than 6 months. With these synthesis reanalysis using more stringent success criteria, all studies showed support for short-term improvement, but none demonstrated any support for long-term benefit.

Complications of adhesiolysis with spinal endoscopy include dural puncture, spinal cord compression, catheter shearing, infection, injury from the endoscope, and overadministration of fluid. The epidural infusion of high volumes of fluid, especially hypertonic saline, can potentially cause excessive epidural hydrostatic pressure, resulting in spinal cord compression, elevated intraspinal or intracranial pressure epidural hematoma, bleeding, increased intraocular pressure with resultant visual deficiencies including blindness, and dural rupture. [137]

Unintended subarachnoid or subdural puncture with injection of local anesthetic or hypertonic saline can also occur with resultant neural catastrophe. [137] Hypertonic saline injection into the subarachnoid space has been reported to cause cardiac arrhythmia, myelopathy, and loss of sphincter control. [137, 195] Arachnoiditis and shearing of the catheter with retention has also been reported with epidural adhesiolysis and hypertonic saline. [196, 197, 198] In summary, these procedures should only be performed under fluoroscopic control by well-trained, experienced spinal interventionalists.

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