A systematic review 1 including 5 RCTs and 9 observational studies with a total of 893 subjects was abstracted in DARE. There were 4 RCTs (n=278) and 4 observational studies (n=275) of percutaneous adhesiolysis and 1 RCT (n=83) and 5 observational studies (n=257) of spinal endoscopic adhesiolysis. All 4 RCTs reported positive results for percutaneous adhesiolysis compared with catheterisation without adhesiolysis, physical therapy, exercise and medication, or patients acting as their own control. All 4 observational studies reported short- term improvements; three also reported long-term improvements. Percutaneous adhesiolysis was superior to epidural steroid injection (anaesthetic, steroid and saline via catheterisation without adhesiolysis) in both the short term and long term in 1 RCT. Another RCT and 2 observational studies in patients who had all failed with epidural steroid injections reported improvements with adhesiolysis. One RCT reported no adverse effects. Adverse effects reported in other studies included subarachnoid block (6 out of 204 patients), subarachnoid puncture (in 4 of 178 procedures) and serious infection (1 out of 129).
The RCT reported significant improvements in pain relief and return to work in patients who were treated with spinal endoscopic adhesiolysis compared with endoscopy without adhesiolysis. The 5 observational studies showed improvement or reported positive short- and long-term results. Spinal endoscopy was superior to epidural steroid injections in the RCT. Reported complications were said to be minor and to include back soreness and dural puncture, but no infections.
Comment: The quality of evidence is downgraded by review limitations (poor reporting of the review procedures, results and study quality) and by inconsistency (heterogeneity in interventions and outcomes). More work is needed to determine the characteristics of patients who may have the best outcomes with adhesiolysis techniques.
Primary/Secondary Keywords