Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome

Abstract

Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). Objectives: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. Study Design: This study used a case control, blind study. Setting: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure. Results: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Limitations: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty

Analysis of the efficacy of retrodiscal approach percutaneous epidural adhesiolysis with WHIP catheter® in patients with lumbar radiculopathy: A retrospective study

“…In a study by Salem et al, no significant difference was found among these 3 approaches in reducing pain and improving function in patients with post-lumbar surgery syndrome. [4,13] Recently, a contralateral interlaminar retrograde approach has been introduced. [5] When performing PEA via a transforaminal approach, 2 options are available: an approach through the safe triangle and an approach through the retrodiscal space.…”

“…In a study by Salem et al, no significant difference was found among these 3 approaches in reducing pain and improving function in patients with post-lumbar surgery syndrome. [ 4 , 13 ] Recently, a contralateral interlaminar retrograde approach has been introduced. [ 5 ]…”

“…[3] PEA for lumbar lesions can be performed via various routes. Typical approaches include the caudal, transforaminal, and S1 approaches, [4] and a contralateral interlaminar retrograde approach has also been recently introduced. [5] The transforaminal approach PEA requires a catheter specifically designed for the transforaminal approach because the space for the catheter to pass through is narrower than that in the caudal or interlaminar approach.…”

“…PEA for lumbar lesions can be performed via various routes. Typical approaches include the caudal, transforaminal, and S1 approaches, [ 4 ] and a contralateral interlaminar retrograde approach has also been recently introduced. [ 5 ]…”