Adhesiolysis and targeted steroid/local anesthetic injection during epiduroscopy alleviates pain and reduces sensory nerve dysfunction in patients with chronic sciatica

Sakai, Tetsuya; Aoki, Hiroshi; Hojo, Mariko; Takada, Masafumi; Murata, Hiroaki; Sumikawa, Koji

doi:10.1007/s00540-008-0616-4

Cited by 34 publications

(28 citation statements)

References 24 publications

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“…No significant differences were found between the groups for any of the measures at any time 77 . Observational studies showed good short‐ and long‐term pain relief 78–83 …”

Section: Treatment Optionsmentioning

confidence: 89%

11. Lumbosacral Radicular Pain

et al. 2010

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Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral radicular pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral radicular pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral radicular pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.

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“…No significant differences were found between the groups for any of the measures at any time 77 . Observational studies showed good short‐ and long‐term pain relief 78–83 …”

Section: Treatment Optionsmentioning

confidence: 89%

11. Lumbosacral Radicular Pain

et al. 2010

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“…Several smaller prospective studies have shown positive results and a lack of serious complications [57-60]. One study utilized an interlaminar approach and is notable for dural puncture in 4 of 19 patients (21.1%), one of whom required hospitalization [61].…”

Section: Epiduroscopy and Adhesiolysismentioning

confidence: 99%

Epidural Lysis of Adhesions

et al. 2014

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As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

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“…Initially we were pleased to see some patients getting 3 to 4 months of relief and report seeing recovery of footdrops. This philosophy still proves to be true even in studies in 2008 by Sakai et al [44] in which they found that adhesiolysis with catheter-directed steroid and local anesthetic injection during epiduroscopy alleviated pain and reduced sensory nerve dysfunction in patients with chronic sciatica. The evolution of these findings has changed the process into what it is today [45].…”

Section: Discussionmentioning

confidence: 99%