The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Epidural Adhesiolysis in Low Back Pain

요통환자에서 경막외 유착 용해술에 의한 제통효과

  • Lee, Sang-Chul (Department of Anesthesiology, Seoul National University College of Medicine) ;
  • Oh, Wan-Soo (Department of Anesthesiology, Seoul National University College of Medicine) ;
  • Kim, Jin-Kyoung (Department of Anesthesiology, Seoul National University College of Medicine) ;
  • Roh, Chang-Joon (Department of Anesthesiology, Seoul National University College of Medicine) ;
  • Son, Jong-Chan (Seoul Branch of Kunkuk University Hospital)
  • 이상철 (서울대학교 의과대학 마취과학교실) ;
  • 오완수 (서울대학교 의과대학 마취과학교실) ;
  • 김진경 (서울대학교 의과대학 마취과학교실) ;
  • 노창준 (서울대학교 의과대학 마취과학교실) ;
  • 손종찬
  • Published : 1997.11.22
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Abstract

Background: Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatment of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging(MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adhesiolysis in patients with low back pain. Methods: We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesion site under fluoroscopic guidance. Injection of contrast dye was achieved and prospected spread of agents. Injection of 0.25% bupivacaine, triamcinolone, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 months. We also looked for complication of epidural adhesiolysis. Results: Statistical analysis(Friedman nonparametric repeated measures test and Dune's multiple comparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis(P<0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P<0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappeared after a few months without residual sequelae. Conclusion: We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibrosis and adhesion. A direct visualization by epiduroscopy may be more useful to the resulting functional changes after epidural adhesiolysis.

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