Epidural Lysis of Adhesions

Lee, Frank; Jamison, David; Hurley, Robert W.; Cohen, Steven P.

doi:10.3344/kjp.2014.27.1.3

Cited by 73 publications

(67 citation statements)

References 75 publications

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“…Available systematic reviews have reached different conclusions about the efficacy of PEAN in managing lumbar PLSS (11)(12)(13)(14)(15)(16). The aim of this study was to determine the efficacy as well as the complication rates of all 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) in treating lumbar PLSS.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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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

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Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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“…-Hialuronidasa 1.500 u con evidencia conflictiva (33). -Corticoides metilprednisolona 80-120 mg o betametaxona 6 mg (se recomienda no utilizar corticoides particulados por su toxicidad neuronal).…”

Section: Tiempo Quirúrgicounclassified

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

Iglesias

Nieto

2014

Rev. Soc. Esp. Dolor

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Nieto Iglesias C, Andrés Nieto I. Epiduroscopia (interventional endoscopy spinal surgery). Procedimiento endoscó-pico quirúrgico espinal. Rev Soc Esp Dolor 2014; 21(5): 281-293. INTRODUCCIÓNLa epiduroscopia, endoscopia espinal o también llamado IESS (interventional endoscopy spinal surgery -procedimiento endoscópico quirúrgico espinal) es un procedimiento de los llamados mínimamente invasivos, que permite visualizar el espacio epidural (en tiempo real) con fines diagnósticos y terapéuticos, en pacientes que padecen lumbalgia o lumbociatalgias crónicas refractarias a tratamientos convencionales, mediante la utilización de un epiduroscopio flexible, de pequeño tamaño, con una fibra óptica insertada y con la posibilidad de utilizar pequeños instrumentos para el tratamiento de los pacientes.La lumbalgia o lumbociatalgia se ha transformado en un grave problema sanitario y social ya que la incidencia anual afecta, en un 45 %, a la población de entre 35 y 50 años, constituyendo el 13 % de las causas de absentismo laboral, cifras que van en aumento exponencial, dada nuestra larga esperanza de vida. Lo cierto es que el 80-90 % de la población general padecerá este tipo de dolor alguna vez en la vida. Afortunadamente, estos episodios (60-80 %) ceden en el plazo de pocas semanas, pero alrededor de un 7-10 % desarrollarán dolor crónico (aunque para algunos autores esta cifra puede alcanzar hasta el 33 %) (1), lo que les hace subsidiarios de múltiples tratamientos médicos y quirúrgicos, que pueden fracasar, con un impacto brutal sobre su calidad de vida y estado funcional, así como un tremendo coste social (2).Según las diferentes publicaciones se considera que entre un 40 a un 80 % de los pacientes que han sufrido una intervención quirúrgica sobre la columna vertebral, mantendrán algún tipo de dolor e incluso empeorarán, o lo que es lo mismo, solo uno de cada cuatro experimentarán alguna mejoría. Este problema se denomina "síndrome de cirugía fallida de espalda" o en inglés "failed back surgery syndrome" (FBSS). Los peores resultados afectarán a aquellos pacientes que sufran más de una intervención (3). Este cuadro clínico, que consiste en la persistencia de dolor lumbar con o sin irradiación a miembros inferiores, constituye la mayor fuente de pacientes subsidiarios de esta técnica.El IESS ofrece una serie de ventajas sobre otros procedimientos, siendo poco agresivo y con escasas complicaciones, tales como:1. Visualización de tejidos normales y anormales (adherencias, inflamación…), tanto del espacio epidural posterior (espacio de trabajo habitual para la lisis de adherencias) como anterior. 2. Posibilidad de realización de biopsias. 3. Confirmación el diagnóstico del origen del dolor. 4. Lavado de sustancias proinflamatorias y algogénicas en el lugar de la lesión (mediante infusión de suero salino). 5. Depósito de sustancias terapéuticas en el lugar de la lesión (anestésicos locales, hialuronidasa, corticoides, ozono, clonidina…). 6. Lisis mecánica de adherencias (con balón o el propio epiduroscopio) y/o mediante la utili...

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“…Another issue with epidural anesthesia that causes relatively high failure rates is the inconsistency of the cranial extent of epidural extension. [16][17][18] A solution to assist with overcoming the two stated challenges is the use of contrast dye intraoperatively in conjunction with fluoroscopy. Injecting dye to confirm placement and cranial extent of epidural drugs has improved the success rates of performing lumbar surgery under this modality.…”

Section: Introductionmentioning

confidence: 99%

<p>Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery</p>

Kang¹,

Kashlan²,

Singh³

et al. 2020

JPR

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Background: With the increase in life expectancy seen throughout the world, the prevalence of degenerative spinal pathology and surgery to treat it has increased. Spinal surgery under general anesthesia leads to various problems and complications, especially in patients with numerous medical comorbidities or elderly patients. For this reason, there is a need for safer anesthetic methods applicable to unhealthy, elderly patients undergoing spinal surgery. Purpose: To report our experience with utilizing fluoroscopy-guided epidural anesthesia in conjunction with conscious sedation in spinal surgery. Patients and Methods: We performed a retrospective review of 111 patients at our institution that received fluoroscopy-guided epidural anesthesia for lumbar surgery from February to September 2018. Patients' records were evaluated to evaluate patient demographics, American Society of Anesthesiology Physical Classification System (ASA) class, and pain numerical rating scores (NRS) preoperatively and throughout their recovery postoperatively. Intraoperative data including volume of epidural anesthetic used, extent of epidural spread, and inadvertent subdural injection was collected. Postoperative recovery time was also collected. Results: The mean age of our patients was 60 years old with a range between 31 and 83 years old. All patients experienced decreases in postoperative pain with no significant differences based on age or ASA class. There was no association between ASA class and time to recovery postoperatively. Older patients (age 70 years or greater) had a significantly longer recovery time when compared to younger patients. Recovery also was longer for patients who received higher volumes of epidural anesthesia. For every 1 mL increase of epidural anesthetic given, there was an increase in the extent of spread of 1.8 spinal levels. Conclusion: We demonstrate the safety and feasibility of utilizing conscious sedation in conjunction with fluoroscopy-guided epidural anesthesia in the lumbar spinal surgery.

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Epidural Lysis of Adhesions

Cited by 73 publications

References 75 publications

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

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

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

<p>Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery</p>

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