1. 2004;7;177-186One Day Lumbar Epidural Adhesiolysis and Hypertonic Saline Neurolysis in Treatment of Chronic Low Back Pain: A Randomized, Double-Blind Trial
   An Original Contribution
   Laxmaiah Manchikanti, MD, Jose J. Rivera, MD, Vidyasagar Pampati, MSc, Kim S. Damron, RN, Carla D. McManus, RN, BSN, Doris E, Brandon, CST, and Sue R, Wilson, ORT.

Background: Chronic, refractory low back pain and/or lower extremity is a common problem. Percutaneous adhesiolysis with hypertonic saline neurolysis was described in the management of chronic refractory low back pain and/or lower extremity, non-responsive to conservative modalities of management.

Objective: To determine the ability of percutaneous adhesiolysis and hypertonic saline administration to reduce pain and improve functional and psychological status in patients with chronic low back pain and/or lower extremity.

Design: Randomized, double-blind, controlled trial.

Methods: A total of 75 patients were studied, with 25 patients in each group. Three types of interventions were included, with Group I serving as control with catheterization without adhesiolysis, followed by injection of local anesthetic, normal saline, and steroid. Group II consisted of catheterization and adhesiolysis, followed by injection of local anesthetic, normal saline, and steroid. Group III consisted of adhesiolysis followed by injection of local anesthetic, hypertonic saline, and steroid. Statistical analysis incorporated intent-to-treat analysis.

Outcome Measures: Visual Analogue Scale pain scores, Oswestry Disability Index, work status, opioid intake, range of motion measurement, and P-3 ®. Significant pain relief was defined as average relief of 50% or greater.

Results: Significant improvement was seen in patients in Group II and III, at 3 months, 6 months, and 12 months, compared to baseline measurements, as well as compared to Group I without adhesiolysis. Seventy-two percent of patients in Group III (adhesiolysis and hypertonic neurolysis), 60% of patients in Group II (adhesiolysis only), compared to 0% in Group I (control) showed significant improvement at 12-month follow up. The average number of treatments for one year were 2.76 in Group II and 2.16 in Group III. Duration of significant relief with the first procedure was 2.8 ± 1.49 months in Group II and 3.8 ± 3.37 months in Group III.

Conclusion: Percutaneous adhesiolysis, with or without hypertonic saline neurolysis, is an effective treatment for chronic low back pain and/or lower extremity.

Keywords: Chronic low back pain, adhesiolysis, hypertonic saline neurolysis, epidural fibrosis .