Epidural Adhesiolysis in Low Back Pain

Lee, Sang Chul; Oh, Wan Soo; Kim, Jin Kyoung; Roh, Chang Joon; Son, Jong Chan

Abstract

BACKGROUND
Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatrnent of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging (MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adheslolysis in patients with low back pain.
METHODS
We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesian site under fluoroscopic guidance. Injection of contrast dye was achieved and praspected spread of agents. Injection of 0.25% bupivacaine, triamcinolcme, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief umerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 montbs. We also looked for complication of epidural adhesiolysis.
RESULTS
Statistical analysis (Friedman nonparametric repeated measures test and Dune's multiple eomparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis (P < 0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P <0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappaeed after a few months without residual sequelae.
CONCLUSION
We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibmsis and adhesion. A direct visualization by epiduroscopy may be more useful to the resolting functional changes after epidural adhesiolysis.