title: Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update.
abstract: BACKGROUND
  Percutaneous epidural adhesiolysis and spinal endoscopic adhesiolysis are interventional pain management techniques used to treat patients with refractory low back pain due to epidural scarring. Standard epidural steroid injections are often ineffective, especially in patients with prior back surgery. Adhesions in the epidural space can prevent the flow of medicine to the target area; lysis of these adhesions can improve the delivery of medication to the affected areas, potentially improving the therapeutic efficacy of the injected medications.
  
  
  METHODS
  A systematic review utilizing the methodologic quality criteria of the Cochrane Musculoskeletal Review Group for randomized trials and the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials.
  
  
  OBJECTIVE
  To evaluate and update the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis in managing chronic low back and lower extremity pain due to radiculopathy, with or without prior lumbar surgery, since the 2005 systematic review.
  
  
  METHODS
  Basic search identified the relevant literature, in the MEDLINE, EMBASE, and BioMed databases (November 2004 to September 2006). Manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years were reviewed. Randomized and non-randomized studies are included in the review based on criteria established. Percutaneous adhesiolysis and endoscopic adhesiolysis are analyzed separately.
  
  
  METHODS
  The primary outcome measure was significant pain relief (50% or greater). Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term relief was defined as less than 3 months, and long-term relief was defined as 3 months or longer.
  
  
  RESULTS
  Studies regarding the treatment of epidural adhesions for the treatment of low back and lower extremity pain were sought and reviewed. The evidence from the previous systematic review was combined with new studies since November 2004. There is strong evidence for short term and moderate evidence for long term effectiveness of percutaneous adhesiolysis and spinal endoscopy.
  
  
  CONCLUSIONS
  Percutaneous adhesiolysis and spinal endoscopy may be effective interventions to treat low back and lower extremity pain caused by epidural adhesions.
authors.affiliation: University of FL, Gainesville, FL, USA. amt57@aol.com
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Trescot
authors.forename: Pradeep
authors.initials: P
authors.lastname: Chopra
authors.forename: Salahadin
authors.initials: S
authors.lastname: Abdi
authors.forename: Sukdeb
authors.initials: S
authors.lastname: Datta
authors.forename: David M
authors.initials: DM
authors.lastname: Schultz
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D004724:Endoscopy; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D007278:Injections, Spinal / Q000009:adverse effects; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D020393:Manipulation, Spinal; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery; D013131:Spine / Q000187:drug effects / Q000473:pathology; D000267:Tissue Adhesions / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D006821:Hyaluronoglucosaminidase