• Ayman Abd Al-Maksoud Yousef, Ali Seif EL-Deen, and Ali Ead Al-Deeb.
• Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt. ayman.yousef@rocketmail.com
• Pain Pract. 2010 Nov 1;10(6):548-53.

BackgroundFailed back surgery syndrome (FBSS) has been reported to account for up to 40% of patients with chronic low back pain. Epidural fibrosis may be responsible for up to 30% of all cases of FBSS. Perineural fibrosis can interfere with cerebrospinal fluid-mediated nutrition, rendering the nerve root hyperesthetic and hypersensitive to compression. Traditionally, steroid injection has been used to treat low back pain and radiculopathy. The addition of hyaluronidase to the injectate has been reported to reduce the degree of fibrosis.AimTo evaluate the role of hyaluronidase when added to fluoroscopically guided caudal steroid and hypertonic saline in patients with FBSS.MethodsThirty-eight patients with back pain because of FBSS were studied. Twenty patients received fluoroscopically guided caudal epidural steroid, local anesthetic, and hypertonic saline in combination (group 1), and 18 patients received fluoroscopically guided caudal epidural steroid, hypertonic saline, local anesthetic, and hyaluronidase (group 2). Patients were asked to rate their pain using a verbal scale of 0 to 4 (0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = extremely severe). Lumbar spine range of motion and opioid intake were measured.ResultSignificant improvement in short-term pain relief was noted in both groups, while significant long-term pain relief was only achieved in group 2 patients.ConclusionThe addition of hyaluronidase to fluoroscopically guided caudal epidural steroid and hypertonic saline combination improved long-term pain relief in patients with FBSS.© 2010 The Authors. Pain Practice © 2010 World Institute of Pain.

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