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EPIDURAL ADHESIOLYSIS IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN IN FAILED BACK SURGERY SYNDROME AND IN LUMBAR RADICULAR PAIN: FIRST YEAR OF EXPERIENCE AT PULA GENERAL HOSPITAL, PULA, CROATIA – A RANDOMIZED TRIAL
LADA KALAGAC FABRIS
orcid.org/0000-0001-8645-2128
; Pula General Hospital, Department of Anesthesiology, ICU and Pain Therapy, Pula, Croatia
ALEKSANDAR ŠUPUT
; Pula General Hospital, Department of Anesthesiology, ICU and Pain Therapy, Pula, Croatia
NADOMIR GUSIĆ
; Department of Surgery and Neurosurgery, Pula, Croatia
PREDRAG MAMONTOV
; Department of Surgery and Neurosurgery, Pula, Croatia
Abstract
Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p<0.001). Improvement in short-term pain relief resulted in signifi cant reduction in pharmacotherapy use (p<0.001) and clinical effectiveness rate of >50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.
Keywords
epidural adhesiolysis; failed back surgery syndrome; chronic radicular pain; hyaluronidase; clinical outcome
Hrčak ID:
218963
URI
Publication date:
4.4.2019.
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