• Matthijs W Geudeke, Annelot C Krediet, Süleyman Bilecen, HuygenFrank J P MFJPMDepartment of Anesthesiology, Pain Clinic, University Medical Center Utrecht, Utrecht, The Netherlands.Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands., and Mienke Rijsdijk.
• Department of Anesthesiology, Pain Clinic, University Medical Center Utrecht, Utrecht, The Netherlands.
• Pain Pract. 2021 Apr 1; 21 (4): 468481468-481.

IntroductionLow-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 MaterialsA 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.ResultsFrom 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.ConclusionCurrent 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.© 2020 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.

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