Epidural Adhesiolysis in the Management of Chronic Low Back Pain in Failed Back Surgery Syndrome and in Lumbar Radicular Pain: First Year of Experience in General Hospital Pula - Croatia, A Randomized Trial

Objective: To evaluate the efficacy and the feasibility of percutaneous adhesiolysis to reduce pain, to improve daily functions and reduce drugs intake in patient with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, inflammation, 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 the purpose of achieving pain relief. Methods: Standard percutaneus epidural adhesiolysis was preformed in 54 patients who were divided into two groups: pain from FBSS versus chronic radicular pain without previous spine surgery.Visual analog score (VAS), change in pharmacotherapy intake, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, in the 4th and 12th week after the intervention. Results: VAS scores for pain were significanty reduced in both groups in the 4th and 12th week. Statistically significantly decrease was expressed in the Radiculopathy group (VAS0 =7.5 0.87 / VAS12th= 4.6 1.05) versus the FBSS group (VAS0 = 7.6 0.85 / VAS12th= 5.0±1.58) (p<0.001) Improvement in short-term pain relief resulted in significant reduction in pharmacotherapy intake (p<0.001) and clinical effectivenes rate of >50% was achieved in 27% patients of FBSS and 25% of patient with chronic radicular pain without surgery experience. Conclusion: Considering our small sample, our results in short-term pain relief, suggests that epidurolysis can be an effective method in the treatment of patients with chronic radicular pain like in the patients with FBSS.