Abstract

RACZ, G.  and  FLORES, J. C.. Percutaneous Epidural lysis of adhesions. Rev. Soc. Esp. Dolor [online]. 2012, vol.19, n.6, pp.310-317. ISSN 1134-8046.

Chances are relatively high that each of us will experience low back pain at some point in our lives. The usual course is rapid improvement with 5-10% developing persistent symptoms (1). In the 1990's, the estimated cost of low back pain to the health industry was in the billions of dollars, and with a larger proportion of our population now reported to be older, this number can only be expected to increase (2,3). Treatment typically begins with conservative measures such as medication and physical therapy and may even include minimally and highly invasive pain management interventions. Surgery is sometimes required in patients who have progressive neurological deficits or those who have other therapies. A quandary sometimes arises, following a primary surgery, as to whether repeat surgery should be attempted or another alternative technique should be tried. This is the exact problem that the epidural adhesiolysis procedure was has a significant surgery sparing role that can help. It was shown to free up nerves and to break down scar formation, deliver site-specific corticosteroids and local anesthetics, and reduce edema with the use of hyaluronidase and hypertonic saline. Epidural adhesiolysis has afforded patients a reduction in pain and neurological symptoms without the expense and occasional long recovery period associated with repeat surgery, and often prevents the need for surgical intervention. This is the reason that Epidural Adhesiolysis was given an evidence rating of strong correlating to a 1B or 1C evidence level for Post-Lumbar Surgery Syndrome in the most recent American Society of Interventional Pain Physicians evidence-based guidelines. This suggests that the therapy is supported by observational studies and case series along with randomized-control trials. Recommendation was also made that this therapy could apply to most patients in most circumstances without reservations. Additionally CPT codes have been assigned to the two different kinds of adhesiolysis, CPT 62263 for the three times injections over 2-3 days, usually done as in patient hospital setting and CPT 62264 for the one time injection series surgery-center model that may need to be repeated 3 to 3.5 times in a 12 months period time. In this review we talk about from the patophisiology and epidemiology to indications and patient preparation.

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