OBJECTIVES The authors evaluated the effectiveness of percutaneous epidural adhesiolysis (PEA) in patients with low back pain due to contained disc herniation. PATIENTS AND METHODS Twenty patients with low back pain due to contained disc herniation underwent PEA treatment with the Racz technique. The patients were evaluated for pain score, medication intake, significant pain relief, and compl...

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. ...

BACKGROUND Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. STUDY DESIGN The study is an ...

BACKGROUND Cervical disc disease is a common and occasionally disabling condition, occurring as a natural consequence of aging in the vast majority of the adult population. Percutaneous epidural neuroplasty (PEN) has been used to deliver highly concentrated drugs for chronic neck pain and to prevent scarring in cases refractory to conventional epidural blocks. However, the clinical course after...

BACKGROUND Chronic lower back pain with or without radiculopathy represents an important medical, social, and economic problem. Many treatment modalities and techniques, including surgery and epidural administration of steroids, have been used to manage this pain. Hypertonic saline, which has been used as an adjunct to percutaneous epidural adhesiolysis, can also be injected via a transforamina...

BACKGROUND: Chronic spinal pain is the most prevalent chronic disease with employment of multiple modes interventional techniques including epidural interventions. Multiple randomized controlled trials (RCTs), observational studies, systematic reviews, and guidelines have been published. The recent review utilization patterns expenditures show that there has a decline in injections decrease inf...

a considerable number of patients complaining of pain after spinal surgery reportedly have adhesions and fibrosis in the epidural space [1, 2]. Also, patients with chronic low back pain and/or radicular pain may have perineural adhesions due to perineural and neurogenic inflammation from mechanical or chemical irritation, while they don't have any history of surgery [3, 4]. Parke et al. [5] dis...

Interventional pain management, and the interventional techniques which are an integral part of that specialty, are subject to widely varying definitions and practices. How interventional techniques are applied by various specialties is highly variable, even for the most common procedures and conditions. At the same time, many payors, publications, and guidelines are showing increasing interest...