The Helm Center for Pain Management, Laguna Hills, CA 92637, USA.
Pain Physician. 2013 Apr;16(2 Suppl):SE125-50.
Post lumbar surgery syndrome refers to pain occurring or present after lumbar surgery. While the causes of pain after lumbar surgery are multi-factorial, scarring is a significant source of that pain. Low back and/or leg pain after lumbar surgery can persist despite appropriate conservative therapy. Spinal endoscopy allows direct visual evaluation of the epidural space, along with mechanical lysis of any adhesions present.
A systematic review of the effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome.
To evaluate and update the effectiveness of spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome.
The available literature on spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies.The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles.
Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as improvement of 12 months or less; whereas, long-term effectiveness was defined 12 months or longer.
For this systematic review, 21 studies were identified. Of these, one randomized controlled trial (RCT) and 5 observational studies met the inclusion criteria. Two of the observational studies were excluded because of other methodological issues, despite showing positive outcomes.Using current criteria for successful outcomes, these studies indicate that there is fair evidence for the effectiveness of spinal endoscopy in the treatment of persistent low back and/or leg pain in post lumbar surgery syndrome.
The limitations of this systematic review include the paucity of literature.
The evidence is fair that spinal endoscopy is effective in the treatment of post lumbar surgery syndrome.
腰椎手术后综合征是指腰椎手术后出现或存在的疼痛。虽然腰椎手术后疼痛的原因是多因素的，但瘢痕形成是疼痛的一个重要来源。尽管进行了适当的保守治疗，腰椎手术后仍可能持续出现腰背或下肢疼痛。脊柱内窥镜检查可直接观察硬脊膜外腔，并对任何存在的粘连进行机械松解。
腰椎手术后综合征中脊柱内窥镜粘连松解术有效性的系统评价。
评估和更新脊柱内窥镜粘连松解术治疗腰椎手术后综合征的效果。
对治疗腰椎手术后综合征的脊柱内窥镜粘连松解术相关文献进行了系统评价。使用的质量评估和临床相关性标准是 Cochrane 肌肉骨骼系统评价组针对随机试验干预技术的标准，以及纽卡斯尔-渥太华量表标准针对观察性研究的标准。根据美国预防服务工作组（USPSTF）制定的证据质量标准，将证据水平分为良好、中等、有限或较差。资料来源包括通过对 1966 年至 2012 年 9 月期间的 PubMed 和 EMBASE 进行检索，以及对已知的主要和综述文章的参考文献进行手工检索而确定的相关文献。
疼痛缓解和功能改善是主要结局测量指标。其他结局测量指标包括心理状态、阿片类药物摄入和重返工作的改善。短期疗效定义为 12 个月或更短时间内的改善；而长期疗效定义为 12 个月或更长时间内的改善。
本系统评价共确定了 21 项研究。其中，1 项随机对照试验（RCT）和 5 项观察性研究符合纳入标准。尽管显示出积极的结果，但由于存在其他方法学问题，有 2 项观察性研究被排除在外。根据目前成功结局的标准，这些研究表明，脊柱内窥镜在治疗腰椎手术后综合征中的持续性腰背或下肢疼痛方面具有中等证据支持。
本系统评价的局限性包括文献资料不足。
有中等证据表明脊柱内窥镜在治疗腰椎手术后综合征方面有效。
