Spinal Endoscopy and Lysis of Epidural Adhesions in the Management of Chronic Low Back Pain

Abstract

Spinal endoscopy with epidural adhesiolysis is an interventional pain management technique which emerged during the 1990s. It is an invasive but important treatment modality in managing chronic low back pain that is nonresponsive to other modalities of treatment, including percutaneous spring guided adhesiolysis and transforaminal epidural injections. While epidural adhesions most commonly result following surgical intervention of the spine, leakage of disc material into the epidural space following an anular tear, or an inflammatory response can also result in their formation. Even though advanced technology, including computerized tomography and magnetic resonance imaging,have made significant advances in the diagnosis of epidural fibrosis, it is believed that epidural adhesions resulting in chronic persistent pain are poorly managed. Percutaneous endoscopic lysis of epidural scar tissue has been shown to be cost effective and a safe modality. This review discusses various aspects of endoscopic adhesiolysis, including clinical effectiveness, complications, rationale, and indications.