Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis
| Autor: | Annelot C. Krediet, Matthijs W. Geudeke, Süleyman Bilecen, Frank J. P. M. Huygen, Mienke Rijsdijk |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Visual analogue scale MEDLINE Review Article leg pain 03 medical and health sciences 0302 clinical medicine systematic review Quality of life 030202 anesthesiology Activities of Daily Living medicine Humans Prospective Studies Review Articles Retrospective Studies endoscopic adhesiolysis business.industry epiduroscopy recurrent low‐back pain Confidence interval Oswestry Disability Index Critical appraisal Treatment Outcome Anesthesiology and Pain Medicine Meta-analysis Quality of Life Physical therapy failed back surgery syndrome business 030217 neurology & neurosurgery Failed back surgery |
| Zdroj: | Pain Practice |
| ISSN: | 1533-2500 1530-7085 |
| DOI: | 10.1111/papr.12974 |
| Popis: | Introduction Low‐back or leg pain in patients suffering from failed back surgery syndrome (FBSS) is often severe, having a major impact on functionality and quality of life. Despite conservative and surgical treatments, pain can be persistent. An alternative treatment option is epiduroscopy, a minimally invasive procedure based on mechanical adhesiolysis of epidural fibrosis. As epidural fibrosis is speculated to be a major contributor in the pathophysiologic process of FBSS, this review evaluates the effectiveness of epiduroscopy in FBSS patients. Methods and materials A systematic literature search was performed in PubMed, Embase, and Cochrane databases. Critical appraisal was performed using validated tools. Meta‐analysis was performed using generic inverse variance analysis. Results From the 286 identified articles, nine studies were included. The visual analogue scale (VAS) average was 7.6 at baseline, 4.5 at 6, and 4.3 at 12 months. The Oswestry Disability Index (ODI) average was 61.7% at baseline, 42.8% at 6, and 46.9% at 12 months. An average of 49% of patients experienced significant pain relief at 6 and 37% at 12 months. Meta‐analysis showed a pooled VAS mean difference of 3.4 (2.6 to 4.1; 95% confidence interval [CI]) and 2.8 (1.6 to 4.0; 95% CI) and pooled ODI mean difference of 19.4% (12.5 to 26.4%; 95% CI) and 19.8% (13.8 to 25.9%; 95% CI) at 6 and 12 months, respectively. Conclusion Current literature demonstrates a clinically relevant reduction in pain and disability scores at 6 to 12 months after mechanical adhesiolysis in FBSS patients. The quality of evidence is moderate, and the level of recommendation is weak. Practitioners should consider the benefits of epiduroscopy after weighing the risks for individual patients with FBSS. |
| Databáze: | OpenAIRE |
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