title: Efficacy of Percutaneous Adhesiolysis in the Treatment of Lumbar Post Surgery Syndrome.
abstract: BACKGROUND
  Lumbar post-surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis is often contemplated in managing lumbar post surgery syndrome. Recent guidelines and systematic reviews have reached different conclusions about the level of evidence for the efficacy of epidural injections and percutaneous adhesiolysis in managing lumbar post surgery syndrome. The objective of this systematic review was to determine the efficacy of all 3 percutaneous adhesiolysis anatomical approaches (caudal, interlaminar, and transforaminal) in treating lumbar post-surgery syndrome.
  
  
  METHODS
  
  
  
  METHODS
  A literature search was performed from 1966 through October 2014 utilizing multiple databases.
  
  
  METHODS
  A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and percutaneous adhesiolysis in managing lumbar post-surgery syndrome was performed including methodological quality assessment utilizing Cochrane review criteria, Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB), and grading of evidence using 5 levels of evidence ranging from Level I to Level V.
  
  
  METHODS
  The search strategy emphasized post-surgery syndrome and related pathologies treated with percutaneous adhesiolysis procedures.
  
  
  RESULTS
  The search criteria yielded 16 manuscripts on percutaneous adhesiolysis assessing post-surgery syndrome. Of these, only 4 randomized trials met inclusion criteria for methodological quality assessment, 3 of them were of high quality; and the fourth manuscript was of low quality. Based on these 3 randomized controlled trials, 2 of them with one-day procedure and one with a 3-day procedure, the level of evidence for the efficacy of percutaneous adhesiolysis is Level II based on best evidence synthesis.
  
  
  CONCLUSIONS
  Based on this systematic review, percutaneous adhesiolysis is effective in managing patients with lumbar post-surgery syndrome after the failure of conservative management including fluoroscopically directed epidural injections.
authors: Pain Management Center of Paducah, University of Louisville, Louisville, Kentucky, USA.
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA.
authors: Kavita N
authors: KN
authors: Manchikanti
authors: NYU School of Medicine, NYU Langone-Hospital for Joint Diseases, New York, USA.
authors: Christopher G
authors: CG
authors: Gharibo
authors: LSU Health Science Center, New Orleans, Louisiana, USA.
authors: Alan D
authors: AD
authors: Kaye
keywords: Epidural Fibrosis; Injections, Epidural; Percutaneous Adhesiolysis; Post Lumbar Surgery Syndrome; Randomized Controlled Trial