Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Background: Post lumbar surgery syndrome is common and often results in chronic, persistentpain and disability, which can lead to multiple interventions. After failure of conservative treatment,either surgical treatment or a nonsurgical modality of treatment such as epidural injections,percutaneous adhesiolysis are often contemplated in managing post lumbar surgery syndrome.Multiple previous systematic reviews have reached discordant conclusions about the level ofevidence for the effectiveness of percutaneous adhesiolysis in managing post lumbar surgerysyndrome and other conditions.Study Design: A systematic review of previously published systematic reviews assessing efficacyof percutaneous adhesiolysis in managing post lumbar surgery syndrome.Objective: To evaluate the value and validity of previous systematic reviews performed after 2015on effectiveness of percutaneous adhesiolysis in managing chronic refractory low back and lowerextremity pain secondary to post lumbar surgery syndrome.Methods: Previous systematic reviews on percutaneous adhesiolysis were evaluated. The qualityof each systematic review was assessed by Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews (AMSTAR).The randomized trials included in the available systematic reviews were assessed by Cochranereview criteria and Interventional Pain Management techniques - Quality Appraisal of Reliabilityand Risk of Bias Assessment (IPM-QRB) for methodologic quality.Data sources included relevant systematic reviews and the randomized trials included in thosesystematic reviews published since 2015 with searches of PubMed, Cochrane reviews, and GoogleScholar through February 2019.Outcome Measures: Outcome measures were significant improvement defined as 50% painrelief and improvement in functional status. Short-term efficacy was defined as improvement of 6months or less, whereas long-term efficacy was defined as more than 6 months.Results: Three systematic reviews and 4 randomized controlled trials (RCTs) of post lumbar surgerysyndrome with chronic refractory low back and lower extremity pain showed notable evidence ofsignificant pain relief. Only one systematic review, which was of low quality with inappropriateanalysis, showed lack of evidence.Conclusion: Overall, the present analysis shows Level I evidence for percutaneous adhesiolysisbased on significant evidence from published RCTs and 3 of the 4 systematic reviews.Key words: Post lumbar surgery syndrome, epidural fibrosis, percutaneous adhesiolysis,systematic reviews, randomized controlled trials