Mechanical Plus Chemical Adhesiolysis During Epiduroscopy After Failed Spine Surgery

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Patients were assigned to receive epiduroscopy with mechanical lysis of the epidural fibrotic attachment alone or in combination with a hyaluronidase/corticosteroid solution.
Patients were assigned to receive epiduroscopy with mechanical lysis of the epidural fibrotic attachment alone or in combination with a hyaluronidase/corticosteroid solution.

Administration of hyaluronidase and corticosteroid methylprednisolone acetate to the epidural space during epiduroscopy for failed back surgery-related radicular pain may improve back pain and disability at 1 year, according to a study published in Pain Medicine.

In this randomized double-blind trial (Clinicaltrials.gov identifier: NCT02459392), 45 patients (age ≥18 years; with permanent low back pain and >60% radicular pain) with failed back surgery syndrome were randomly assigned to receive epiduroscopy with mechanical lysis of the epidural fibrotic attachment (ie, with laser, radiofrequency, or a balloon technique) alone (n=22), or in combination with a hyaluronidase (Hylase “Dessau”) plus corticosteroid methylprednisolone acetate (DEPOMedrol; 80 mg injection) solution administered at the depression in the spinal root (n=23).

Patients were examined at 6 months and at 1 year after the procedure. An 11-point numeric rating scale and the Oswestry Disability Index were used to assess pain intensity (in the legs and back) and disability, respectively.

After 6 months, patients in both groups reported improvements in leg and back pain and disability (P <.05 for all). These improvements were not sustained at the 1-year follow-up, with the exception of improvement of back pain (P <.05).

Patients receiving the mechanical lysis alone vs in combination with chemical lysis reported greater treatment satisfaction at 6 months and at 1 year (P <.05).

The relatively small sample size is the main study limitation.

“Epiduroscopy has great potential to become an effective and well-accepted diagnostic and therapeutic tool in the treatment of [failed back surgery syndrome-related] symptoms.”

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Reference

Rapčan R, Kočan L, Mláka J, et al. A randomized, multicenter, double-blind, parallel pilot study assessing the effect of mechanical adhesiolysis vs adhesiolysis with corticosteroid and hyaluronidase administration into the epidural space during epiduroscopy [published online March 23, 2018]. Pain Med. doi: 10.1093/pm/pnx328

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