Korean J Pain.  2021 Jun;34(3):346-368. 10.3344/kjp.2021.34.3.346.

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

• Manchikanti L
• Knezevic E
• Knezevic NN
• Sanapati MR
• Kaye AD
• Thota S
• Hirsch JA

• KMID: 2517519
• DOI: http://doi.org/10.3344/kjp.2021.34.3.346

Abstract

Background
Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management.
Methods
An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months).
Results
This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence.
Conclusions
Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

Keyword

Catheterization; Epidural Space; Evidence-Based Medicine; Intervertebral Disc Displacement; Low Back Pain; Meta-Analysis; Observational Study; Pain Management; Radiculopathy; Randomized Controlled Trial; Saline Solution; Hypertonic; Systematic Review

Figure

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  Fig. 1 Flow diagram illustrating published literature evaluating percutaneous adhesiolysis/neurolysis in lumbar disc herniation.

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  Fig. 2 Changes in pain and functional status from baseline at 6 months. (A) Change in pain levels using the numeric rating scale from baseline at 6 months in patients treated with adhesiolysis/neurolysis. (B) Change in functionality status scores using the Oswestry Disability Index from baseline at 6 months in patients treated with adhesiolysis/neurolysis. CI: confidence interval, df: degrees of freedom.

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  Fig. 3 Changes in pain and functional status from baseline at 12 months. (A) Change in pain levels using the numeric rating scale from baseline at 12 months in patients treated with adhesiolysis/neurolysis. (B) Change in functionality scores using the Oswestry Disability Index from baseline at 12 months in patients treated with adhesiolysis/neurolysis. CI: confidence interval, df: degrees of freedom.

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