Clinical Experience of Epidural Adhesiolysis in Patients with Failed Back Surgery Syndrome

Abstract

Background: Epidural adhesiolysis is advocated in radiculopathy due to epidural adhesion following previous back surgery. Traditionally, a Racz catheter through a R-K needle is used as a standard tool in this procedure. We report our experiences of clinical results and the usage of various catheters for epidural adhesiolysis in patients with failed back surgery syndrome. Methods: We investigated the medical records of 15 patients with failed back surgery syndrome who received epidural adhesiolysis. An R-K epidural needle was inserted through the sacral hiatus and a Racz catheter was advanced through the needle and repeatedly passed through the adhesion site under fluoroscopic visualization. The authors used Racz catheter in addition to the several kinds of catheter, e.g., the Fogarty balloon, and pulmonary artery or ureteral catheters to improve the epidural adhesion lysis. Bupivacaine, triamcinolone, hypertonic saline and/or hyaluronic acid were injected through the catheter daily for 3 days. Patients were evaluated for pain intensity and side effects 3 days and 2 months after the procedure. Results: Pain scores (numerical rating scale) were significantly lower at 3 days and 2 months (3.1 1.8, 5.7 2.0, respectively P 0.9). Complications were 2 mild posterior neck pain during procedure and 1 myoclonus in the recovery room. Conclusions: We conclude that epidural adhesiolysis is a relatively effective therapeutic means in patients with failed back surgery syndrome. Furthermore, a new balloon catheter with the advantages of Racz and Fogarty catheters, should be made available to improve the quality of lysis.