Epidural lysis of adhesions.
As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, USA.
Frank
F
Lee
Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA.
David E
DE
Jamison
Department of Anesthesiology, Neurology, Psychiatry & Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA.
Robert W
RW
Hurley
Department of Anesthesiology and Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, and Walter Reed National Military Medical Center, Baltimore, USA.
Steven P
SP
Cohen
epidural adhesiolysis; epidural lysis of adhesions; epidural neuroplasty; epiduroscopy; failed back surgery syndrome