Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Schwartz, DO, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Brinkman, BS, Foster, BS, Miro, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Manchikanti, MD, Pain Management Centers of America, Paducah, KY. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):74-90.
This review presents epidurolysis as a procedure to alleviate pain and disability from epidural adhesions. It reviews novel and groundbreaking evidence, describing the background, indications, benefits and adverse events from this procedure in an effort to provide healthcare experts with the data required to decide on an intervention for their patients.
Epidural adhesions (EA) or epidural fibrosis (EF) is defined as non-physiologic scar formation secondary to a local inflammatory reaction provoked by tissue trauma in the epidural space. Often, it is a sequelae of surgical spine intervention or instrumentation. The cost associated with chronic post-operative back pain has been reported to be up to nearly $12,500 dollars per year; this, coupled with the increasing prevalence of chronic lower back pain and the subsequent increase in surgical management of back pain, renders EF a significant cost and morbidity in the U.S. Though risk factors leading to the development of EA are not well established, epidural fibrosis has been reported to be the culprit in up to 46% of cases of Failed Back Surgery Syndrome (FBSS), a chronic pain condition found in up to 20-54% of patients who receive back surgery. Moreover, EF has also been associated with lumbar radiculopathy after lumbar disc surgery. Epidurolysis is defined as the mechanical dissolution of epidural fibrotic scar tissue for persistent axial spine or radicular pain due to epidural fibrosis that is refractory to conservative therapy Endoscopic lysis of adhesions is a procedural technique which has been shown to improve chronic back pain in one-third to one-half of patients with clinically symptomatic fibrous adhesions. Here we review some of the novel evidence that supports this procedure in EA and FBSS.
The literature concerning epidurolysis in the management of epidural adhesions is insufficient. Prospective studies, including randomized controlled trials and observational studies, have suggested epidurolysis to be effective in terms of pain reduction, functional improvement, and patient satisfaction scores. Observational studies report epidurolysis as a well-tolerated, safe procedure. Current evidence suggests that epidurolysis may be used as an effective treatment modality for epidural adhesions. Nonetheless, further high quality randomized controlled studies assessing the safety and efficacy of epidurolysis in the management of epidural adhesions is needed.
本篇综述将介绍硬膜松解术，作为一种减轻硬膜外粘连引起的疼痛和残疾的方法。本文综述了新的开创性证据，描述了该手术的背景、适应证、益处和不良事件，旨在为医疗保健专家提供决策患者干预措施所需的数据。
硬膜外粘连（EA）或硬膜外纤维化（EF）是指由于硬膜外空间的组织创伤引起的局部炎症反应导致的非生理性瘢痕形成。它通常是脊柱手术干预或器械治疗的后遗症。据报道，慢性术后背痛的相关成本高达每年近 12500 美元；加上慢性下腰痛的患病率不断增加以及随后对腰痛的手术治疗增加，EF 在美国造成了显著的成本和发病率。虽然导致 EA 发展的风险因素尚未得到很好的确定，但硬膜外纤维化已被报道是失败的背部手术综合征（FBSS）的罪魁祸首，在接受背部手术的患者中，这种慢性疼痛疾病的发生率高达 20-54%。此外，EF 也与腰椎间盘手术后的腰椎神经根病变有关。硬膜松解术定义为由于硬膜外纤维化导致的持续性轴向脊柱或神经根疼痛，对保守治疗无效时，机械溶解硬膜外纤维疤痕组织。粘连内镜松解术是一种已被证明可改善三分之一至一半有临床症状的纤维性粘连的慢性背痛的手术技术。在这里，我们回顾了一些支持该手术治疗 EA 和 FBSS 的新证据。
关于硬膜外松解术治疗硬膜外粘连的文献不足。前瞻性研究，包括随机对照试验和观察性研究，表明硬膜外松解术在减轻疼痛、改善功能和提高患者满意度方面是有效的。观察性研究报告硬膜外松解术是一种耐受性良好、安全的手术。目前的证据表明，硬膜外松解术可能被用作治疗硬膜外粘连的有效治疗方法。然而，需要进一步进行高质量的随机对照研究，评估硬膜外松解术在治疗硬膜外粘连中的安全性和有效性。
