Effectiveness of Spinal Endoscopic Adhesiolysis
in Post Lumbar Surgery Syndrome:
A Systematic Review
Authors: Hayek Salim M. 
Published: March 2021

Background: Post lumbar surgery syndrome with persistent chronic low back and lower extremity pain
is common in the United States. Epidural fibrosis may account for as much as 20% to 36% of all cases
of failed back surgery syndrome (FBSS). Percutaneous adhesiolysis with a catheter or direct visualization
of the spinal canal and the contents with an endoscope are techniques employed in resistant cases when
patients fail to respond to conservative modalities of treatment, including fluoroscopically directed epidural injections. Some patients failing to respond to percutaneous adhesiolysis are candidates for spinal endoscopic adhesiolysis. However, literature evaluating the effectiveness of spinal endoscopic adhesiolysis is
sparse and discussions continue about its effectiveness, utility, and complications.
Study Design: A systematic review of the available literature.
Objective: To evaluate the effectiveness and safety of spinal endoscopic adhesiolysis in the management of chronic low back and lower extremity pain in post surgical patients with chronic recalcitrant pain, non-responsive to conservative modalities of management and fluoroscopically directed epidural injections.
Methods: A search of relevant resources (PubMed, EMBASE, and the Cochrane database) was
accomplished and the resulting publications were examined based on the inclusion/exclusion criteria set forth. Randomized controlled trials and observational studies were included in the search.
Two reviewers assessed the studies’ methodologies and outcomes. Randomized clinical trials were
assessed and scored based on the criteria established by the Cochrane methodological assessment
criteria of randomized clinical trials and the observational studies were assessed and scored based
on the Agency for Healthcare Research and Quality (AHRQ) criteria.
Clinical relevance was evaluated utilizing Cochrane review criteria.
Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II.
Outcome Measures: The primary outcome measure was pain relief (≥ 50%) in follow-up for
at least 6 months. Pain relief for longer than 6 months was considered long-term and 6 months
or less was considered short-term. The secondary outcome measures were functional and psychological status, return to work, patient satisfaction, and opioid intake.
Results: Of the 13 studies considered for inclusion, one randomized trial and 5 observational
studies met inclusion criteria for evidence synthesis based on the inclusion criteria and methodologic quality scores of 50 or more.
The indicated level of evidence for endoscopic adhesiolysis is Level II-1 or II-2 evidence for shortand long-term relief based on the U.S. Preventive Services Task Force (USPSTF) criteria.
Limitations: There was a paucity of literature for randomized trials.
Conclusion: Spinal endoscopic adhesiolysis may be used as an effective treatment modality for
chronic refractory low back pain and radiculopathy that is related to epidural adhesions.
Key words: Chronic low back pain, lower extremity pain, lumbar post surgery syndrome, failed
back surgery syndrome, percutaneous adhesiolysis, endoscopic adhesiolysis, epidural adhesions,
epidural fibrosis