Evaluation of the efficacy of epiduroscopic adhesiolysis in Failed Back Surgery Syndrome

Abstract

Backgraund and Aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing tretment protocol. Methods: Eighty-two patients with FBSS symtoms were included. Two groups were composed as group I (stabilized) and group II (non-stabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the Patient Satisfaction Scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were as 7.8 and 3.28 points in group I (p<0.001) and as 7.51 and 2.74 points in group II (p<0.001) at the beginning and 12th months, respectively. Mean ODI scores were as 34.05 and 22.16 points in group I (p<0.001) and as 30.74 and 19.46 points in group II (p<0.001) at the beginning and 12th months. VAS and ODI scores decreased significantly in both groups, but were more significant in non-stabilized group (p<0.001). Moderate or severe fibrous tissue was observed in 86.58% and patient satisfaction scores were very good or good in 78.06%. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the non-stabilization group, although none of these patients developed a spinal headache, and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis and the possible course of the present findings and may be more effective in unstabilized patients. Key Words: Failed back surgery syndrome, epiduroscopic adhesiolysis, hyaluronidase.