title: Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial.
abstract: BACKGROUND
  The literature is replete with evaluations of failed surgery, illustrating a 9.5%-25% reoperation rate. Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, recurrent disc herniation, sacroiliac joint pain, and facet joint pain among other causes.
  
  
  METHODS
  Patients (n = 120) were randomly assigned to two groups with a 2-year follow-up. Group I (control group, n = 60) received caudal epidural injections with catheterization up to S3 with local anesthetic (lidocaine 2%, 5 mL), nonparticulate betamethasone (6 mg, 1 mL), and 6 mL of 0.9% sodium chloride solution. Group II (intervention group, n = 60) received percutaneous adhesiolysis of the targeted area, with targeted delivery of lidocaine 2% (5 mL), 10% hypertonic sodium chloride solution (6 mL), and nonparticulate betamethasone (6 mg). The multiple outcome measures included the Numeric Rating Scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as 50% improvement in pain and Oswestry Disability Index scores.
  
  
  RESULTS
  Significant improvement with at least 50% relief with pain and improvement in functional status was illustrated in 82% of patients at the 2-year follow-up in the intervention group compared to 5% in the control group receiving caudal epidural injections. The average number of procedures over a period of 2 years in Group II was 6.4 ± 2.35 with overall total relief of approximately 78 weeks out of 104 weeks.
  
  
  CONCLUSIONS
  The results of this study show significant improvement in 82% of patients over a period of 2 years with an average of six to seven procedures of 1-day percutaneous adhesiolysis in patients with failed back surgery syndrome.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY ; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
keywords: epidural adhesions; epidural fibrosis; epidural steroid injections