PMID- 19305488
OWN - NLM
STAT- MEDLINE
DCOM- 20090724
LR  - 20220318
IS  - 1533-3159 (Print)
IS  - 1533-3159 (Linking)
VI  - 12
IP  - 2
DP  - 2009 Mar-Apr
TI  - Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: 
      a systematic review.
PG  - 419-35
AB  - BACKGROUND: Post lumbar surgery syndrome with persistent chronic low back and 
      lower extremity pain is common in the United States. Epidural fibrosis may 
      account for as much as 20% to 36% of all cases of failed back surgery syndrome 
      (FBSS). Percutaneous adhesiolysis with a catheter or direct visualization of the 
      spinal canal and the contents with an endoscope are techniques employed in 
      resistant cases when patients fail to respond to conservative modalities of 
      treatment, including fluoroscopically directed epidural injections. Some patients 
      failing to respond to percutaneous adhesiolysis are candidates for spinal 
      endoscopic adhesiolysis. However, literature evaluating the effectiveness of 
      spinal endoscopic adhesiolysis is sparse and discussions continue about its 
      effectiveness, utility, and complications. STUDY DESIGN: A systematic review of 
      the available literature. OBJECTIVE: To evaluate the effectiveness and safety of 
      spinal endoscopic adhesiolysis in the management of chronic low back and lower 
      extremity pain in post surgical patients with chronic recalcitrant pain, 
      non-responsive to conservative modalities of management and fluoroscopically 
      directed epidural injections. METHODS: A search of relevant resources (PubMed, 
      EMBASE, and the Cochrane database) was accomplished and the resulting 
      publications were examined based on the inclusion/exclusion criteria set forth. 
      Randomized controlled trials and observational studies were included in the 
      search. Two reviewers assessed the studies' methodologies and outcomes. 
      Randomized clinical trials were assessed and scored based on the criteria 
      established by the Cochrane methodological assessment criteria of randomized 
      clinical trials and the observational studies were assessed and scored based on 
      the Agency for Healthcare Research and Quality (AHRQ) criteria. Clinical 
      relevance was evaluated utilizing Cochrane review criteria. Analysis was 
      conducted using 5 levels of evidence, ranging from Level I to III, with 3 
      subcategories in Level II. OUTCOME MEASURES: The primary outcome measure was pain 
      relief (> or = 50%) in follow-up for at least 6 months. Pain relief for longer 
      than 6 months was considered long-term and 6 months or less was considered 
      short-term. The secondary outcome measures were functional and psychological 
      status, return to work, patient satisfaction, and opioid intake. RESULTS: Of the 
      13 studies considered for inclusion, one randomized trial and 5 observational 
      studies met inclusion criteria for evidence synthesis based on the inclusion 
      criteria and methodologic quality scores of 50 or more. The indicated level of 
      evidence for endoscopic adhesiolysis is Level II-1 or II-2 evidence for short- 
      and long-term relief based on the U.S. Preventive Services Task Force (USPSTF) 
      criteria. LIMITATIONS: There was a paucity of literature for randomized trials. 
      CONCLUSION: Spinal endoscopic adhesiolysis may be used as an effective treatment 
      modality for chronic refractory low back pain and radiculopathy that is related 
      to epidural adhesions.
FAU - Hayek, Salim M
AU  - Hayek SM
AD  - University Hospitals and Outcomes Research Consortium, Cleveland, OH 44106, USA. 
      salim.hayek@UHhospitals.org
FAU - Helm, Standiford
AU  - Helm S
FAU - Benyamin, Ramsin M
AU  - Benyamin RM
FAU - Singh, Vijay
AU  - Singh V
FAU - Bryce, David A
AU  - Bryce DA
FAU - Smith, Howard S
AU  - Smith HS
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
SB  - IM
MH  - Chronic Disease
MH  - Evidence-Based Medicine
MH  - Failed Back Surgery Syndrome/pathology/*surgery
MH  - Humans
MH  - Injections, Spinal/adverse effects/methods
MH  - Low Back Pain/etiology/pathology/*surgery
MH  - Lumbosacral Region/surgery
MH  - *Neuroendoscopy
MH  - Pain Measurement/methods
MH  - Recovery of Function
MH  - Tissue Adhesions/pathology
MH  - Treatment Outcome
RF  - 123
EDAT- 2009/03/24 09:00
MHDA- 2009/07/25 09:00
CRDT- 2009/03/24 09:00
PHST- 2009/03/24 09:00 [entrez]
PHST- 2009/03/24 09:00 [pubmed]
PHST- 2009/07/25 09:00 [medline]
PST - ppublish
SO  - Pain Physician. 2009 Mar-Apr;12(2):419-35.