Purpose of Review

The growing prevalence of spinal pain in the USA continues to produce substantial economic impact and strain on health-related quality of life. Percutaneous adhesiolysis is utilized for recalcitrant, resistant conditions involving spinal pain when epidural injections have failed to provide adequate improvement, especially low back and lower extremity pain, specifically in post-lumbar surgery syndrome. Despite multiple publications and systematic reviews, the debate continues in reference to effectiveness, safety, appropriate utilization, and medical necessity of percutaneous adhesiolysis in chronic pain. This systematic review, therefore, was undertaken to evaluate and to update effectiveness of percutaneous adhesiolysis to treat chronic refractory low back and lower extremity pain, post-surgical patients of the lumbar spine.

Recent Findings

From 2009 to 2016, there was a decline of 53.2% utilization of percutaneous adhesiolysis with an annual decline of 10.3% per 100,000 fee-for-service (FFS) Medicare population. Multiple insurers, including Medicare, with Medicare area contractors of Noridian and Palmetto have issued noncoverage policies for percutaneous adhesiolysis resulting in these steep declines and continued noncoverage by Medicare Advantage plans, Managed Care plans of Medicaid, and other insurers. Since 2005, 4 systematic reviews of percutaneous adhesiolysis were published with 3 of them showing proper methodology and appropriate results with effectiveness of adhesiolysis, whereas one poorly performed systematic review showed negative results. In addition, there were only 4 randomized controlled trials (RCTs) to be included in the previous systematic reviews of post-surgery syndrome, whereas now, the RCTs and other studies have increased.

Summary

This systematic review shows level I or strong evidence for the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain related to post-lumbar surgery syndrome.

中文翻译：

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经皮黏附溶解术对治疗术后综合征中的慢性腰背和下肢疼痛有效吗：系统评价和荟萃分析。

审查目的

在美国，脊椎疼痛的日益流行继续对经济相关的生活质量产生实质性的经济影响和压力。当硬膜外注射未能提供足够的改善，特别是腰部和下肢疼痛，尤其是腰部手术后综合症时，经皮粘连溶解可用于顽固性，抵抗性疾病，包括脊柱疼痛。尽管有许多出版物和系统的综述，但关于慢性疼痛中经皮粘连溶解的有效性，安全性，合理利用和医学必要性的争论仍在继续。因此，进行了这项系统的评估，以评估和更新经皮黏附溶解治疗腰椎手术后顽固性慢性难治性腰背和下肢疼痛的效果。

最近的发现

从2009年到2016年，经皮粘连溶解的使用率下降了53.2％，每100,000服务付费（FFS）的Medicare人口每年下降10.3％。包括Medicare在内的多家保险公司，以及Noridian和Palmetto的Medicare地区承包商，都发布了针对经皮粘连的非承保政策，导致这种急剧下降，并被Medicare Advantage计划，Medicaid的Managed Care计划和其他保险公司继续承保。自2005年以来，发表了4篇关于经皮黏附溶解的系统评价，其中3篇显示了正确的方法学和适当的结果，证明了黏附溶解的有效性，而一项表现不佳的系统评价则显示了负面结果。此外，

概要

该系统评价显示了I级或有力证据证明经皮粘连溶解治疗与腰椎手术后综合症相关的慢性下背部和下肢疼痛的有效性。