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Clinical Research Article

Korean J Pain 2021; 34(3): 346-368

Published online July 1, 2021 https://doi.org/10.3344/kjp.2021.34.3.346

Copyright © The Korean Pain Society.

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

Laxmaiah Manchikanti1 , Emilija Knezevic2 , Nebojsa Nick Knezevic3 , Mahendra R. Sanapati1 , Alan D. Kaye4 , Srinivasa Thota1 , Joshua A. Hirsch5

1Pain Management Centers of America, Paducah, KY & Evansville, IN, USA
2University of Illinois at Urbana-Champaign, College of Liberal Arts and Sciences, Champaign, IL, USA
3Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA
4LSU Health Sciences Center, Shreveport, Ochsner Shreveport Hospital and Pain Clinic Feist-Wieller Cancer Center, Shreveport, LA, USA
5Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Correspondence to:Laxmaiah Manchikanti
Pain Management Centers of America, 67 Lakeview Drive, Paducah, Kentucky 42001, USA
Tel: +1-270-554-8373, ext. 4101
Fax: +1-270-554-8987
E-mail: drlm@thepainmd.com

Handling Editor: Kyung Hoon Kim

Received: April 30, 2021; Revised: May 27, 2021; Accepted: May 28, 2021

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

Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management.
Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months).
Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence.
Conclusions: Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

Keywords: Catheterization, Epidural Space, Evidence-Based Medicine, Intervertebral Disc Displacement, Low Back Pain, Meta-Analysis, Observational Study, Pain Management, Radiculopathy, Randomized Controlled Trial, Saline Solution, Hypertonic, Systematic Review.