A prospective study on functional outcome of Percutaneous Epiduroscopic Adhesiolysis compared to lumbar spine surgery for treatment of Failed Back Lumbar Syndrome caused by Fibrosis–Adhesion


background: Epidural fibrosis and adhesion seen as common post lumbar syndrome phenomena which contribute to 50%-60% recurrent of the symptoms.Aim of study: We studied the effectiveness of percutaneous epiduroscopic adhesiolysis in management of fibrosis & adhesion resultant from failed backed lumbar spine surgery compared to second time surgical decompression with surgical excision of the fibrosis of lumbar spinal stenosis.Patients & Methods: In a prospective comparative study of 44 patients all of them with failed backed post laminectomy syndrome were diagnosed in Sulaimania city private clinic and private hospital, from June 2010 till May 2012 according to magnetic resonance imaging techniques, also according to inclusion exclusion criteria in diagnosis of adhesion with fibrosis, were randomized into two groups. Group A treated by lumbar spine surgery with second time surgical exploration, decompression and excision of fibrosis compared to the second group B were treated by percutaneous epiduroscopic adhesiolysis through sacral canal under fluoroscopic guide. The caudal epidurogram showed restriction in spread of contrast caused by fibrosis & adhesion then the canal open by irrigation through pressurized saline range from 40 to 80 ml according to the number of the level which were obstructed by fibrosis. Saline used intermittently until the spinal canal open were seen by fluoroscope until complete procedure with adequate adhesiolysis with visualization of the canal opening. At the end of the procedure solutions were used to decrease rate of adhesion. Depomedrol 80 mg 2ml , Hyaluronate 6ml, 1% 5ml lignocaine injected into canal space.Results & Discussion: In both group A by surgical procedure & B percutaneous epiduroscopic adhesiolysis were noticed significant improvement in the mean of Stanford score and ODI (Oswestry low back disability score) from baseline were at all follow up visit for 24 Months according to sciatica pain (short term less than 6 Months, long term more than 6 Months), Functional outcome, Return back to work, psychological status, Change in narcotic intake, with the general satisfaction rate. Also there were significant statistical differences at 12, 24 Months follow up for both Stanford and ODI Oswestry index between group A and group B revealed high outcome results for group B was treated by epiduroscopic adhesiolysis technique (P- value <0.0001) with minimal complications rate in group B compared to group A.Conclusion: We concluded that percutaneous epiduroscopic adhesiolysis for 2 years follow up specific for the patients of fibrosis with adhesion post laminectomy are superior to the surgical exploration with excision of fibrosis & second time decompression in treatment of failed back lumbar spinal surgery.