Epidural lysis of adhesions for failed back surgery and spinal stenosis: Factors associated with treatment outcome

Eugene Hsu, Levan Atanelov, Anthony R. Plunkett, Nu Chai, Yian Chen, Steven Cohen

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes. METHODS:: We performed this multicenter, retrospective study in 115 patients who underwent LOA for FBSS (n = 104) or spinal stenosis (n = 11) between 2004 and 2007. Twenty-seven demographic, clinical, and procedural variables were extracted from medical records and correlated with the outcome, defined as ≥50% pain relief lasting ≥1 month. Univariable analysis was performed, followed by multivariable logistic regression. RESULTS:: Overall, 48.7% (95% confidence interval [CI], 39.3%-58.1%) of patients experienced a positive outcome. In univariable analysis, those who had a positive outcome were older (mean age 64.1 years; 95% CI, 59.7-68.6 vs 57.2; 95% CI, 53.0-61.4 years; P = 0.02), while higher baseline numerical rating scale pain scores were associated with a negative outcome (mean 6.7 years; 95% CI, 6.0-7.3 vs 7.5; 95% CI, 6.9-8.0; P = 0.07). Use of hyaluronidase did not correlate with outcomes in univariable analysis (odds ratio [OR], 1.2; 95% CI, 0.6-2.5; P = 0.65). In multivariable analysis, age ≥81 years (OR, 7.8; 95% CI, 1.4-53.7), baseline numerical rating scale score ≤9 (OR, 4.4; 95% CI, 1.4-16.3, P = 0.02), and patients on or seeking disability or worker's compensation (OR, 4.4; 95% CI, 1.1-19.5, P = 0.04) were significantly more likely to experience a positive outcome. CONCLUSIONS:: Considering our modest success rate, selecting patients for epidural LOA based on demographic and clinical factors may help better select treatment candidates. Procedural factors such as the use of hyaluronidase that increase risks and costs did not improve outcomes, so further research is needed before these become standard practice.

Original languageEnglish (US)
Pages (from-to)215-224
Number of pages10
JournalAnesthesia and Analgesia
Volume118
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Spinal Stenosis
Confidence Intervals
Failed Back Surgery Syndrome
Odds Ratio
Hyaluronoglucosaminidase
Demography
Workers' Compensation
Pain
Multicenter Studies
Medical Records
Retrospective Studies
Logistic Models
Costs and Cost Analysis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Epidural lysis of adhesions for failed back surgery and spinal stenosis : Factors associated with treatment outcome. / Hsu, Eugene; Atanelov, Levan; Plunkett, Anthony R.; Chai, Nu; Chen, Yian; Cohen, Steven.

In: Anesthesia and Analgesia, Vol. 118, No. 1, 01.2014, p. 215-224.

Research output: Contribution to journalArticle

@article{00aa3fb0ee4c45f38571e4a9425e630c,
title = "Epidural lysis of adhesions for failed back surgery and spinal stenosis: Factors associated with treatment outcome",
abstract = "BACKGROUND:: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes. METHODS:: We performed this multicenter, retrospective study in 115 patients who underwent LOA for FBSS (n = 104) or spinal stenosis (n = 11) between 2004 and 2007. Twenty-seven demographic, clinical, and procedural variables were extracted from medical records and correlated with the outcome, defined as ≥50{\%} pain relief lasting ≥1 month. Univariable analysis was performed, followed by multivariable logistic regression. RESULTS:: Overall, 48.7{\%} (95{\%} confidence interval [CI], 39.3{\%}-58.1{\%}) of patients experienced a positive outcome. In univariable analysis, those who had a positive outcome were older (mean age 64.1 years; 95{\%} CI, 59.7-68.6 vs 57.2; 95{\%} CI, 53.0-61.4 years; P = 0.02), while higher baseline numerical rating scale pain scores were associated with a negative outcome (mean 6.7 years; 95{\%} CI, 6.0-7.3 vs 7.5; 95{\%} CI, 6.9-8.0; P = 0.07). Use of hyaluronidase did not correlate with outcomes in univariable analysis (odds ratio [OR], 1.2; 95{\%} CI, 0.6-2.5; P = 0.65). In multivariable analysis, age ≥81 years (OR, 7.8; 95{\%} CI, 1.4-53.7), baseline numerical rating scale score ≤9 (OR, 4.4; 95{\%} CI, 1.4-16.3, P = 0.02), and patients on or seeking disability or worker's compensation (OR, 4.4; 95{\%} CI, 1.1-19.5, P = 0.04) were significantly more likely to experience a positive outcome. CONCLUSIONS:: Considering our modest success rate, selecting patients for epidural LOA based on demographic and clinical factors may help better select treatment candidates. Procedural factors such as the use of hyaluronidase that increase risks and costs did not improve outcomes, so further research is needed before these become standard practice.",
author = "Eugene Hsu and Levan Atanelov and Plunkett, {Anthony R.} and Nu Chai and Yian Chen and Steven Cohen",
year = "2014",
month = "1",
doi = "10.1213/ANE.0000000000000042",
language = "English (US)",
volume = "118",
pages = "215--224",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Epidural lysis of adhesions for failed back surgery and spinal stenosis

T2 - Factors associated with treatment outcome

AU - Hsu, Eugene

AU - Atanelov, Levan

AU - Plunkett, Anthony R.

AU - Chai, Nu

AU - Chen, Yian

AU - Cohen, Steven

PY - 2014/1

Y1 - 2014/1

N2 - BACKGROUND:: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes. METHODS:: We performed this multicenter, retrospective study in 115 patients who underwent LOA for FBSS (n = 104) or spinal stenosis (n = 11) between 2004 and 2007. Twenty-seven demographic, clinical, and procedural variables were extracted from medical records and correlated with the outcome, defined as ≥50% pain relief lasting ≥1 month. Univariable analysis was performed, followed by multivariable logistic regression. RESULTS:: Overall, 48.7% (95% confidence interval [CI], 39.3%-58.1%) of patients experienced a positive outcome. In univariable analysis, those who had a positive outcome were older (mean age 64.1 years; 95% CI, 59.7-68.6 vs 57.2; 95% CI, 53.0-61.4 years; P = 0.02), while higher baseline numerical rating scale pain scores were associated with a negative outcome (mean 6.7 years; 95% CI, 6.0-7.3 vs 7.5; 95% CI, 6.9-8.0; P = 0.07). Use of hyaluronidase did not correlate with outcomes in univariable analysis (odds ratio [OR], 1.2; 95% CI, 0.6-2.5; P = 0.65). In multivariable analysis, age ≥81 years (OR, 7.8; 95% CI, 1.4-53.7), baseline numerical rating scale score ≤9 (OR, 4.4; 95% CI, 1.4-16.3, P = 0.02), and patients on or seeking disability or worker's compensation (OR, 4.4; 95% CI, 1.1-19.5, P = 0.04) were significantly more likely to experience a positive outcome. CONCLUSIONS:: Considering our modest success rate, selecting patients for epidural LOA based on demographic and clinical factors may help better select treatment candidates. Procedural factors such as the use of hyaluronidase that increase risks and costs did not improve outcomes, so further research is needed before these become standard practice.

AB - BACKGROUND:: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes. METHODS:: We performed this multicenter, retrospective study in 115 patients who underwent LOA for FBSS (n = 104) or spinal stenosis (n = 11) between 2004 and 2007. Twenty-seven demographic, clinical, and procedural variables were extracted from medical records and correlated with the outcome, defined as ≥50% pain relief lasting ≥1 month. Univariable analysis was performed, followed by multivariable logistic regression. RESULTS:: Overall, 48.7% (95% confidence interval [CI], 39.3%-58.1%) of patients experienced a positive outcome. In univariable analysis, those who had a positive outcome were older (mean age 64.1 years; 95% CI, 59.7-68.6 vs 57.2; 95% CI, 53.0-61.4 years; P = 0.02), while higher baseline numerical rating scale pain scores were associated with a negative outcome (mean 6.7 years; 95% CI, 6.0-7.3 vs 7.5; 95% CI, 6.9-8.0; P = 0.07). Use of hyaluronidase did not correlate with outcomes in univariable analysis (odds ratio [OR], 1.2; 95% CI, 0.6-2.5; P = 0.65). In multivariable analysis, age ≥81 years (OR, 7.8; 95% CI, 1.4-53.7), baseline numerical rating scale score ≤9 (OR, 4.4; 95% CI, 1.4-16.3, P = 0.02), and patients on or seeking disability or worker's compensation (OR, 4.4; 95% CI, 1.1-19.5, P = 0.04) were significantly more likely to experience a positive outcome. CONCLUSIONS:: Considering our modest success rate, selecting patients for epidural LOA based on demographic and clinical factors may help better select treatment candidates. Procedural factors such as the use of hyaluronidase that increase risks and costs did not improve outcomes, so further research is needed before these become standard practice.

UR - http://www.scopus.com/inward/record.url?scp=84891773418&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891773418&partnerID=8YFLogxK

U2 - 10.1213/ANE.0000000000000042

DO - 10.1213/ANE.0000000000000042

M3 - Article

C2 - 24356168

AN - SCOPUS:84891773418

VL - 118

SP - 215

EP - 224

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 1

ER -