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Brito-Garcia N, Garcia-Perez L, Kovacs FM, et al. Efficacy, Effectiveness, Safety, and Cost-effectiveness of Epidural Adhesiolysis for Treating Failed Back Surgery Syndrome. A Systematic Review. Pain Med. 2018 Dec 24. pii: 5260825. doi: 10.1093/pm/pny233. (Systematic review)
Abstract

Background: Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of life and represents a major clinical challenge and a significant economic burden for society. Adhesiolysis is used as a treatment to eliminate perineural/epidural adhesions in patients with chronic pain attributed to FBSS.

Objective: To evaluate the efficacy, effectiveness, safety, and cost-effectiveness of epidural adhesiolysis compared with other procedures for treating FBSS.

Method: A systematic review was conducted. The electronic databases Medline/PreMedline, EMBASE, Cochrane Library Plus, Centre for Reviews and Dissemination databases, SCOPUS, Science Citation Index, and PEDRO were consulted through April 2017. Predefined criteria were used to determine inclusion of the studies and to assess their methodological quality.

Results: Ten reports were included. No randomized controlled trials (RCTs) on efficacy or cost-effectiveness were found. Three reports (corresponding to two RCTs, N = 212) suggested that adhesiolysis was effective, especially for pain and disability. However, both studies presented serious methodological flaws. In addition to RCTs, seven observational studies with high risk of bias reported data on effectiveness and safety. Fifty-eight adverse events were reported among 130 patients undergoing endoscopic adhesiolysis, and 19 among the 110 undergoing percutaneous adhesiolysis.

Conclusions: The evidence on the efficacy and cost-effectiveness of adhesiolysis for treating FBSS is nonexistent, whereas evidence on its effectiveness and safety is insufficient. Incorporating data from observational studies did not improve the quality of the evidence on effectiveness.

Ratings
Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

Insufficient evidence!

Physician rater

Adhesiolysis, yet unproven. This well designed analysis attempted to identify high quality evidence regarding this modality for chronic back pain. They found none.

Physician rater

The aim of the article was to evaluate the efficacy, effectiveness, safety, and cost-effectiveness of epidural adhesiolysis compared with other procedures for treating failed back surgery syndrome. Analyzing ten articles, the authors highlighted that evidence on the efficacy and cost-effectiveness of adhesiolysis for treating failed back surgery syndrome is nonexistent, whereas evidence on its effectiveness and safety is insufficient.
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