Ann Rehabil Med.  2012 Aug;36(4):466-473. 10.5535/arm.2012.36.4.466.

The Effect of Hyaluronidase in Interlaminar Lumbar Epidural Injection for Failed Back Surgery Syndrome

• Kim SB
• Lee KW
• Lee JH
• Kim MA
• An BW

• KMID: 2266716
• DOI: http://doi.org/10.5535/arm.2012.36.4.466

Abstract

OBJECTIVE
To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI). METHOD: Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI.
RESULTS
After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI.
CONCLUSION
ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.

Keyword

Failed back surgery syndrome; Interlaminar lumbar epidural injection; Hyaluronidase

MeSH Terms

Bupivacaine
Failed Back Surgery Syndrome
Humans
Hyaluronoglucosaminidase
Injections, Epidural
Low Back Pain
Sciatica
Stress, Psychological
Triamcinolone
Bupivacaine
Hyaluronoglucosaminidase
Triamcinolone

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