title: Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis.
abstract: BACKGROUND
  Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.
  
  
  METHODS
  A prospective evaluation.
  
  
  METHODS
  An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
  
  
  OBJECTIVE
  To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.
  
  
  METHODS
  Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.
  
  
  METHODS
  Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores.
  
  
  RESULTS
  Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 71% of patients at the end of 2 years. The overall number of procedures over a period of 2 years were 5.7 ± 2.73.
  
  
  CONCLUSIONS
  The lack of a control group and a prospective design.
  
  
  CONCLUSIONS
  Significant relief and functional status improvement as seen in 71% of the 70 patients with percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic function limiting low back and lower extremity pain with central spinal stenosis after failure of conservatie management and fluoroscopically directed epidural injections.
authors.affiliation: Pain Management Center of Paducah, Paducah, Kentucky, USA.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Carla D
authors.initials: CD
authors.lastname: McManus
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D003251:Constriction, Pathologic / Q000150:complications / Q000151:congenital* / Q000188:drug therapy / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage; D017116:Low Back Pain / Q000150:complications / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000002:abnormalities / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D059408:Pain Management; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012869:Skin Absorption; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy; D013256:Steroids
chemical_list: D000779:Anesthetics, Local; D012462:Saline Solution, Hypertonic; D013256:Steroids; D008012:Lidocaine
keywords: Central spinal stenosis; hypertonic sodium chloride solution; local anesthetics; percutaneous adhesiolysis; steroids