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Percutaneous Epidural Adhesiolysisfor Lumbar Compression Fracture Pain Management.

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PERCUTANEOUS EPIDURAL ADHESIOLYSISFOR LUMBAR COMPRESSION FRACTURE PAIN MANAGEMENT

Farid Yudoyono., Rully Hanafi Dahlan.,M.Zafrullah Arifin.

Divisi Neurospine, Periferal nerve and pain, Neurosurgery Division, Hasan Sadikin Hospital, Padjadjaran University, Faculty of Medicine, Bandung, West Java,Indonesia.

Background: Persistent low back pain secondary post traumatic spine fracture is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal canal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis following traumatic spine fracture. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis following lumbar compression fracturehas not been widely studied.

Study Design: Case series

Setting: An interventional pain management practice

Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with lumbar central spinal stenosis following lumbar compression fracture.

Methods: 3 patients were recruited. All patients received percutaneous adhesiolysis and appropriate placement of the epidural catheter, followed by an injection of 5 mL of 0,5 % ropivacaine at level L1 Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores.

Results: Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 2 of patients at the end of 1 year.

Limitations: The lack of a control group and a prospective design.

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