title: Epidural adhesiolysis: an evidence-based review.
abstract: First described over 25 years ago, epidural lysis of adhesions (LOA) involves the mechanical dissolution of epidural scar tissue, which may directly alleviate pain and facilitate the spread of analgesic substances to area(s) of pain generation. Although it most commonly performed for lumbar failed back surgery syndrome, there is a growing body of evidence that suggests it may be effective for spinal stenosis and radicular pain stemming from a herniated disc. There is weak positive evidence that LOA is more effective than conventional caudal epidural steroid injections for failed back surgery syndrome and spinal stenosis, and that LOA is more effective than sham adhesiolysis and conservative management for lumbosacral radiculopathy. For cervical disc herniation and spinal stenosis, there is only anecdotal evidence suggesting effectiveness and safety. Factors that may contribute to the enhanced efficacy compared to traditional epidural steroid administration include the high volume administered, the use of hypertonic saline, and to a lesser extent the use of hyaluronidase and a navigable catheter to mechanically disrupt scar tissue and guide medication administration. Although LOA is widely considered a safe intervention, the complication rates are higher than for conventional epidural steroid injection.
authors.affiliation: Department of Anesthesiology Walter Reed National Military Medical Center Bethesda, MD, USA2 Department of Anesthesiology and Critical Care Medicine Johns Hopkins School of Medicine, Baltimore, MD, USA3 Department of Anesthesiology and Critical Care Medicine and Physical Medicine and Rehabilitation Johns Hopkins School of Medicine and Depts. of Anesthesiology and Physical Medicine & Rehabilitation,Uniformed Services University of the Health Sciences Bethesda, MD, USA - scohen40@jhmi.edu.
authors.forename: D E
authors.initials: DE
authors.lastname: Jamison
authors.forename: E
authors.initials: E
authors.lastname: Hsu
authors.forename: S P
authors.initials: SP
authors.lastname: Cohen
mesh_terms: D002921:Cicatrix / Q000188:drug therapy* / Q000473:pathology; D004824:Epidural Space / Q000187:drug effects* / Q000473:pathology; D019317:Evidence-Based Medicine; D055111:Failed Back Surgery Syndrome / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use*; D007278:Injections, Spinal; D011843:Radiculopathy / Q000188:drug therapy / Q000473:pathology; D013130:Spinal Stenosis / Q000188:drug therapy* / Q000473:pathology; D000267:Tissue Adhesions / Q000188:drug therapy* / Q000473:pathology
chemical_list: D006821:Hyaluronoglucosaminidase