DESCRIPTION
Lysis of epidural adhesions involves passage of a catheter endoscopically or percutaneously into the epidural space, where it may be manipulated mechanically or injected with various agents (anesthetics, corticosteroids, hyaluronidase or saline) to break up adhesions. The procedure may be performed with fluoroscopic guidance under general anesthesia or conscious sedation. Also known as epidural adhesiolysis, this procedure has been investigated to reduce or eliminate adhesions, fibrosis, or scars which most commonly occur as a complication of spinal surgery and may be included under the diagnosis of “failed back surgery syndrome”. Symptoms of epidural adhesions can include low back pain, radicular pain, muscular spasms and contractures, sphincter disturbances, and motor/sensory disturbances.
Endoscopic epidurolysis is also being investigated for the treatment of degenerative chronic low back pain, including spondylolisthesis, stenosis, and hernia associated with radiculopathy. Along with mechanical adhesiolysis, hyaluronidase, ciprofloxacin and ozone have been applied.
POLICY
Lysis of epidural adhesions, with or without endoscopic guidance, is considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
Published scientific evidence in the form of well-designed studies in peer-reviewed journals regarding the utilization of catheter based lysis of epidural adhesions continues to be lacking. There remains insufficient evidence to permit conclusions regarding this technology at this time.
SOURCES
Gerdesmeyer, L., Wagenpfeil, S., Birkenmaier, C., Veihelmann, A., Hauschild, M., Wagner, K., et al. (2013). Percutaneous epidural lysis of adhesions in chronic lumbar radicular pain: a randomized, double-blind, placebo-controlled trial. Pain Physician, 16, 185-196. (Level 1 evidence)
Helm, S., Hayek, S., M., Colson, J., Chopra, P., Deer, T. R., Justiz, R., et al. (2013). Spinal endoscopic adhesiolysis in post lumbar surgery syndrome: an update of the assessment of the evidence. Pain Physician, 2013 (16) SE125-SE150. (Level 1 evidence)
Hsu, E., Atanelov, L., Plunkett, A., Chai, N., Chen, Y., & Cohen, S. (2014). Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome. Anesthesia Analgesia Journal, 118 (1), 215-24. (Level 4 evidence).
Manchikanti, L., Knezevic, E., Knezevic, N. N., Sanapati, M. R., Kaye, A. D., & Thota, S., et al. (2021). The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis. The Korean Journal of Pain, 34 (3), 346–368. (Level 1 evidence)
National Institute for Health and Clinical Excellence. (2010, February). Procedural guidance: therapeutic endoscopic division of epidural adhesions. Retrieved January 9, 2012 from http://www.nice.org.uk.
Pereiro, P., Severo, M., Monteiro, P., Silva, P., Rebelo, V., Castro-Lopes, J., & Vaz, R. (2014). Results of lumbar endoscopic adhesiolysis using a radiofrequency catheter in patients with postoperative fibrosis and persistent or recurrent symptoms after discectomy. Pain Practice, 16 (1), 67-79. Abstract retrieved March 15, 2016 from PubMed database.
Tuijp, S.J., Van Zundert, J., De Vooght, P., Puylaert, M., Mestrum, R., Heylen, R., & Vanelderen, P. (2018). Does the Use of epiduroscopic lysis of adhesions reduce the need for spinal cord stimulation in failed back surgery syndrome? A short-term pilot study. Pain Practice, 18 (7), 839-844. Abstract retrieved July 22, 2020 from PubMed database.
Winifred S. Hayes, Inc. Health Technology Assessment. (2018, September; last update search October 2022). Percutaneous epidural adhesiolysis for chronic low back pain. Retrieved October 17, 2023 from www.Hayesinc.com/subscribers. (25 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 6/1998
MOST RECENT REVIEW DATE: 12/14/2023
ID_BT
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