Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome

Reg Anesth Pain Med. 2014 May-Jun;39(3):214-8. 



BACKGROUND AND OBJECTIVES:
A number of patients with postlumbar surgery syndrome (PLSS) do not experience satisfactory results after epidural injection. A main reason for failure is surgically induced perineural fibrosis impeding injected material from spreading effectively into the target area. Percutaneous adhesiolysis (PA) has the ability to eliminate the deleterious effects of such adhesions. This study was to evaluate the effectiveness of PA versus transforaminal epidural steroid injection (TFESI) for treating patients with PLSS and to compare the clinical efficacy of PA according to the type of surgery.

METHODS:
This retrospective study included 114 patients who underwent PA or TFESI for chronic pain of at least 3 months duration; all of the patients had undergone lumbar surgery at least 6 months before. For each group, we compared the Numeric Rating Scales for back pain (NRS back) and leg pain (NRS leg) and the Oswestry Disability Index (ODI) before surgery and then 2 weeks and 6 months after surgery. In addition, we divided the PA group into decompression and fusion surgery subgroups, comparing the clinical scores in the 2 subgroups.

RESULTS:
The proportion of successful results was higher for the PA group than for the TFESI group according to 6-month posttreatment NRS back, NRS leg, and ODI scores. Within the PA group, the proportion of successful results was significantly higher in the decompression subgroup than in the fusion group according to 6-month posttreatment NRS leg and ODI scores.

CONCLUSIONS:
Percutaneous adhesiolysis was more effective than TFESI in treating patients with PLSS and also showed better clinical efficacy in the decompression subgroup than in the fusion subgroup.