1 Educational center, National Cheng Kung University Hospital, Tainan city, Taiwan.
2 Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
Outline
Failed back surgery syndrome (FBSS) defined as back pain not resolving to a satisfying level or a new back pain after spinal surgery. The scarring and adhesion in epidural space was considered lead to inflammation then this persisted inflammatory process may rise to more adhesion around nerve roots. So this vicious cycle is hard to break even after another surgery. Epidural injection or another surgery may be considered for those who suffered from persisted pain
after conservative treatments. Except the above treatments, percutaneous epidural adhesiolysis (PEA) is one of the well-known options nowadays. By using Racz
catheter to mechanically lysis adhesion and/or injecting medications such as steroids, saline, local anesthetics or hyaluronidase into epidural space to reduce inflammatory process, PEA can be an effective procedure to relief low back pain with low complication rate. Three randomized controlled trials and 1 observational study were included in this systemic review of PEA in treating low back pain due to FBSS. All of them showed positive results for pain relief and life quality improvement to 6 months after PEA. Besides, the complication rate was low and those complications were mostly self-limited. This review provides good evidence on effectiveness and safety of PEA in dealing with chronic low back pain due to FBSS.
percutaneous epidural, adhesiolysis, failed back, surgery syndrome, low back pain, outcome
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