EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

EPIDURALNA ADHEZIOLIZA U LIJEČENJU KRONIČNE KRALJEŽNIČKE BOLI KOD SINDROMA NEUSPJELE OPERACIJE KRALJEŽNICE I KOD LUMBALNE RADIKULARNE BOLI: JEDNOGODIŠNJE ISKUSTVO U OPĆOJ BOLNICI PULA

Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS.Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS

EPIDURAL ADHESIOLYSIS IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN IN FAILED BACK SURGERY SYNDROME AND IN LUMBAR RADICULAR PAIN: FIRST YEAR OF EXPERIENCE AT PULA GENERAL HOSPITAL, PULA, CROATIA – A RANDOMIZED TRIAL

Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS.Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS

EPIDURAL ADHESIOLYSIS IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN IN FAILED BACK SURGERY SYNDROME AND IN LUMBAR RADICULAR PAIN: FIRST YEAR OF EXPERIENCE AT PULA GENERAL HOSPITAL, PULA, CROATIA – A RANDOMIZED TRIAL

Cilj: Cilj ove randomizirane studije bila je procjena izvodivosti i učinkovitosti adheziolize u liječenju kronične kralježničke boli, njezin utjecaj na poboljšanje kvalitete života, odnosno njezin učinak na kroničnu analgetsku terapiju. Epiduralna adhezioliza omogućava postavljanje posebno dizajniranih katetera u ventrolateralni aspekt epiduralnog prostora, tj. u neposrednoj blizini izlazaćeg živčanog korijena i preciznu primjenu steroida, hijaluronidaze i lokalnih anestetika u cilju smanjenja fenomena boli. Metoda: U studiju su usključena 54 bolesnika podijeljena u dvije skupine: bolesnici s kroničnom boli nakon neuspjele kralježničke operacije (FBSS) naspram bolesnika s kroničnom radikularnom boli bez prethodnog kirurškog iskustva. Nakon 4. odnosno 12. tjedna od postupka praćene su promjene u vizualno analognoj ljestvici boli (VAS), u farmakoterapijiskom unosu, u stupnju subjektivnog životnog zadovoljstva bolesnika, kao i procjena ukupnog učinka adheziolize. Rezultati: Prosječna razina boli (VAS) bila je značajno smanjena u obje skupine i u 4. i u 12. tjednu. Statistički značajno smanjenje izraženo je u skupini radikulopatije (VAS 0 = 7,5 0,87 / VAS 12th = 4,6 1,05) u odnosu na FBSS skupinu (VAS 0 = 7,6 0,85 / VAS 12th = 5,0 1,58) (p 50 % smanjenja inicijalne boli iskazala se u 27 % pacijenata s FBSS i u 25 % bolesnika s kroničnom radikularnom boli. Zaključak: S obzirom na naš mali uzorak, ostvareni rezultati u kratkoročnom ublažavanju boli ukazuju da epiduralna adhezioliza može biti učinkovita metoda u liječenju bolesnika s kroničnom radikularnom boli kao što je to u bolesnika s FBSS.Aim. The aim was to evaluate the effi cacy and feasibility of percutaneous adhesiolysis to reduce pain, improve daily functions and reduce drug use in patients with chronic pain. Chronic radicular pain can be caused by scar tissue, compression, infl ammation, or swelling disks. Adhesiolysis by placement of a wire-bound catheter into the ventrolateral aspect of the epidural space at the site of the exiting nerve root enables precise application of steroids, hyaluronidase, local anesthetics and saline for to achieve pain relief. Methods: Standard percutaneous epidural adhesiolysis was performed in 54 patients divided into two groups: pain from failed back surgery syndrome (FBSS) versus chronic radicular pain without previous spine surgery. Visual analog scale (VAS) score, change in pharmacotherapy used, subjective satisfaction and evaluation of the lysis procedure were observed in pretreatment, and then in the 4th and 12th week of the intervention. Results: VAS scores for pain were signifi cantly reduced in both groups in the 4th and 12th week. A statistically signifi cant decrease was expressed in the radiculopathy group (VAS0=7.5±0.87/VAS12th=4.6±1.05) versus FBSS group (VAS0=7.6±0.85/VAS12th=5.0±1.58) (p50% was achieved in 27% of FBSS patients and 25% of patients with chronic radicular pain without surgery experience. Conclusion: Considering the small sample size, our results in short-term pain relief suggested that epidurolysis could be an effective method in the treatment of patients with chronic radicular pain as in patients with FBSS