• Mert Akbas, Abdel Reheem Elawamy, Haitham Hamby Salem, Ahmed Zaghloul Fouad, Nisreen Adel Abbas, and Gozde Dagistan.
• Algology Division, Department of Anesthesia, Akdeniz University, Antalya, Turkey.
• Pain Physician. 2018 Sep 1; 21 (5): E501-E508.

BackgroundPercutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS).ObjectivesThe purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS.Study DesignThis study used a case control, blind study.SettingThe research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt.MethodsSixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients' baseline levels of pain severity. Follow-up assessments were performed 1-, 3-, and 6-months after the procedure.ResultsResults of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients' satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups.LimitationsOur study was limited by the low number of patients and the short duration (6 months) of follow-up.ConclusionThe 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate.Key WordsPost lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty.

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