Abstract
Background/aim We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing treatment protocol. Materials and methodsEighty-two patients with FBSS symptoms were included. Two groups were composed as group I (stabilized) and group II (nonstabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the patient satisfaction scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. ResultsMean VAS scores were 7.8 and 3.28 points in group I (P < 0.001) and 7.51 and 2.74 points in group II (P < 0.001) at the beginning and at 12 months, respectively. Mean ODI scores were 34.05 and 22.16 points in group I (P < 0.001) and 30.74 and 19.46 points in group II (P < 0.001) at the beginning and at 12 months. VAS and ODI scores decreased significantly in both groups, but were more significant in the nonstabilized group (P < 0.001). Moderate or severe fibrous tissue was observed in 86.58% of the patients and patient satisfaction scores were very good or good in 78.06% of the patients. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the nonstabilization group; however, none of these patients developed a spinal headache and no significant permanent complication arose. ConclusionWe suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients.
Highlights
There is lack of clear consensus related to failed back surgery syndrome (FBSS), many definitions have been provided in the literature [1]
We suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients
In the present study, we found an epiduroscopic adhesiolysis and hyalurinidase-steroid combination to be more effective in the control of pain in patients without stabilization
Summary
There is lack of clear consensus related to failed back surgery syndrome (FBSS), many definitions have been provided in the literature [1]. The signs and symptoms of FBSS are low back pain, radicular pain, sphincter insufficiency, restricted movement, muscle spasms, contractures, and changes in the motor and reflex functions. FBSS treatment can be difficult and ranges from conservative treatment to reoperation [2]. The lysis of scar tissue can be carried out mechanically using epiduroscopy. Be disintegrated, and their evaluation scores may improve. The use of hyaluronidase with steroids in the epidural space may result in greater and longer efficacy than steroids alone [3]. An epiduroscopy refers to an endoscopic technique for the observation
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