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Review Article

Korean J Pain 2014; 27(1): 3-15

Published online January 31, 2014 https://doi.org/10.3344/kjp.2014.27.1.3

Copyright © The Korean Pain Society.

Epidural Lysis of Adhesions

Frank Lee, David E. Jamison*, Robert W. Hurley, and Steven P. Cohen‡*

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, USA.

*Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA.

Department of Anesthesiology, Neurology, Psychiatry & Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA.

Department of Anesthesiology and Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, and Walter Reed National Military Medical Center, Baltimore, USA.

Correspondence to: Steven P. Cohen. Department of Anesthesiology and Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, and Walter Reed National Military Medical Center, 550 North Broadway, Suite 301, Baltimore, MD 21029, USA. Tel: +1-410-955-1818, Fax: +1-410-502-6730, scohen40@jhmi.edu

Received: November 20, 2013; Accepted: November 25, 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

Keywords: epidural adhesiolysis, epidural lysis of adhesions, epidural neuroplasty, epiduroscopy, failed back surgery syndrome