Leoni Matteo Luigi Giuseppe, Occhigrossi Felice, Tenti Michael, Raffaeli William
Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy.
Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Pain Ther. 2025 Feb;14(1):339-357. doi: 10.1007/s40122-024-00695-2. Epub 2024 Dec 20.
Endoscopic epidurolysis (EE) is a minimally invasive procedure used to manage chronic spinal pain, particularly in cases unresponsive to traditional treatments. Despite its growing recognition, the literature lacks comprehensive guidelines on its optimal use. This study utilized a modified Delphi approach to gather expert consensus on best practices for EE in the Italian pain therapy network.
The study's scientific board conducted an extensive literature review to define key investigation topics, including clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was developed and administered to a panel of experts. A two-round Delphi process was implemented, with consensus defined as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements that did not reach consensus in the first round were rephrased and resubmitted in the second round.
Twenty-six clinicians participated in the study, with a 100% response rate in both rounds. In the first round, consensus was achieved for 9 out of 19 statements. In the second round, 8 out of 10 rephrased statements reached the consensus threshold. Key areas of agreement included the clinical indications for EE, the importance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, consensus was not reached on the use of EE for disc herniation with radicular pain and the safety of interlaminar access compared to sacral hiatus access.
The study highlights the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain. The consensus reached by the expert panel provides a framework for best practices, which can guide clinical decision-making and improve patient outcomes. Further research is necessary to validate these findings and address areas where consensus was not achieved.
内镜下硬膜外松解术（EE）是一种用于治疗慢性脊柱疼痛的微创手术，尤其适用于对传统治疗无反应的病例。尽管其认可度不断提高，但文献中缺乏关于其最佳使用的全面指南。本研究采用改良的德尔菲法，在意大利疼痛治疗网络中就EE的最佳实践达成专家共识。
该研究的科学委员会进行了广泛的文献综述，以确定关键研究主题，包括EE的临床适应症、术前评估和技术方面。制定了一份半结构化问卷并分发给专家小组。实施了两轮德尔菲过程，共识定义为在7点李克特量表上至少70%的同意率（同意或强烈同意）。在第一轮中未达成共识的陈述在第二轮中重新措辞并重新提交。
26名临床医生参与了该研究，两轮的回复率均为100%。在第一轮中，19条陈述中有9条达成了共识。在第二轮中，10条重新措辞的陈述中有8条达到了共识阈值。达成共识的关键领域包括EE的临床适应症、术前影像学和麻醉评估的重要性，以及EE特定技术和工具的使用。然而，对于EE用于伴有神经根性疼痛的椎间盘突出症以及与骶裂孔入路相比椎板间入路的安全性，未达成共识。
该研究强调了EE中需要标准化方案，以确保对慢性脊柱疼痛进行一致且有效的治疗。专家小组达成的共识提供了最佳实践框架，可指导临床决策并改善患者预后。有必要进行进一步研究以验证这些发现并解决未达成共识的领域。
