Manchikanti L, Bakhit C E
Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA.
Pain Physician. 2000 Jan;3(1):46-64.
Percutaneous epidural adhesiolysis, lysis of epidural adhesions, percutaneous neuroplasty, or epidural neurolysis is an interventional pain management technique which emerged during the latter part of the 1980s. It is becoming established as a common treatment modality in managing chronic low back pain that is nonresponsive to other modalities of treatment. While epidural adhesions most commonly result following surgical intervention of the spine, leakage of disc material into the epidural space following an annular tear, or an inflammatory response can also result in the formation of epidural adhesions. Even though advanced technology, including computerized tomography and magnetic resonance imaging, have made significant advances in the diagnosis of epidural fibrosis, it is believed that epidural adhesions are best diagnosed by performing an epidurogram. Percutaneous lysis of epidural scar tissue, followed by the injection of hypertonic saline neurolysis, has been shown to be cost effective in multiple studies. This review discusses various aspects of percutaneous nonendoscopic adhesiolysis and hypertonic saline neurolysis including clinical effectiveness, complications, rationale, and indications.
经皮硬膜外粘连松解术、硬膜外粘连松解术、经皮神经成形术或硬膜外神经松解术是一种介入性疼痛管理技术，于20世纪80年代后期出现。它正逐渐成为治疗对其他治疗方式无反应的慢性下腰痛的常用治疗方法。虽然硬膜外粘连最常见于脊柱手术干预后，但椎间盘物质在环状撕裂后漏入硬膜外间隙或炎症反应也可导致硬膜外粘连的形成。尽管包括计算机断层扫描和磁共振成像在内的先进技术在硬膜外纤维化的诊断方面取得了重大进展，但人们认为通过进行硬膜外造影来诊断硬膜外粘连是最好的方法。多项研究表明，经皮溶解硬膜外瘢痕组织，随后注射高渗盐水进行神经松解术具有成本效益。本综述讨论了经皮非内镜粘连松解术和高渗盐水神经松解术的各个方面，包括临床疗效、并发症、原理和适应症。
