Percutaneous lysis of epidural adhesions--evidence for safety and efficacy.

BACKGROUND Percutaneous lysis of epidural adhesions is done worldwide. Over 1.7 million of these procedures were done in the U.S.A. by 2006. This interventional pain management technique is used to treat chronic low back pain (LBP) and/or radiculopathy. The primary object of the approach is to target drug delivery to areas of pathology in the spinal epidural space. The procedure involves removing barriers, such as epidural fibrosis, that prevent drug from reaching target sites. LITERATURE SEARCH Primary sources of information for this manuscript include: (1) 2 systematic literature reviews that include literature published through September 2006; (2) expert opinions; and (3) peer reviewed publications from September 2006 to January 2008. The focus was on percutaneous entry using catheters via the sacral hiatus to treat pain in the lumbosacral region. RESULTS The evidence is strong for short-term efficacy (3 months) and moderate for long-term efficacy (greater than 3 months). Complications do occur, but limited literature exists that documents incidence. CONCLUSION The cumulative evidence through January 2008 show that percutaneous adhesiolysis with targeted drug delivery is an effective treatment for LBP and/or radiculopathy.