Affiliation:
1. 3 Department of Neurology, Ain Shams University, Cairo, Egypt
Abstract
Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to
be safe and effective in treating different spine pathologies, in particular post lumbar surgery
syndrome (PLSS).
Objectives: The purpose of this study was to compare the efficacy and complication rates of the
3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to
treat PLSS.
Study Design: This study used a case control, blind study.
Setting: The research took place at the pain clinic and interventional pain practice room at Asyut
University Hospital, Assiut, Egypt.
Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal,
S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients
underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels
were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual
Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was
performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure.
Results: Results of the group pairwise analysis indicated that, relative to baseline, there were
significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by
patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between
group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across
the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications
between the 3 different groups.
Limitations: Our study was limited by the low number of patients and the short duration (6
months) of follow-up.
Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal)
result in the same outcome with regard to pain relief and complication rate.
Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous
adhesiolysis, Racz catheter, percutaneous neuroplasty
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine