Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: a Systematic Review and Meta-analysis.

Introduction Low back or leg pain in patients suffering from failed back surgery syndrome (FBSS) is often severe, having a major impact on functionality and quality of life. Despite conservative and surgical treatments, pain can be persistent. An alternative treatment option is epiduroscopy: a minimally invasive procedure based on mechanical adhesiolysis of epidural fibrosis. Since epidural fibrosis is speculated to be a major contributor in the pathophysiologic process of FBSS, this review evaluates the effectiveness of epiduroscopy in FBSS patients. Method and material A systematic literature search was performed in PubMed, Embase and Cochrane databases. Critical appraisal was performed using validated tools. Meta-analysis was performed using generic inverse variance analysis. Results From the 286 identified articles, nine studies were included. The Visual Analogue Scale (VAS) average was 7.6 at baseline, 4.5 at six and 4.3 at twelve months. The Oswestry Disability Index (ODI) average was 61.7% at baseline, 42.8% at six and 46.9% at twelve months. An average of 49% of patients experienced significant pain relief at six and 37% at twelve months. Meta-analysis showed a pooled VAS mean difference of 3.4 [2.6-4.1;95%CI] and 2.8 [1.6-4.0;95%CI] and pooled ODI mean difference of 19.4% [12.5-26.4%;95%CI] and 19.8% [13.8-25.9%;95%CI] at 6 and twelve months respectively. Conclusion Current literature demonstrates a clinically relevant reduction in pain and disability scores at six to twelve months after mechanical adhesiolysis in FBSS patients. The quality of evidence is moderate and the level of recommendation is weak. Practitioners should consider the benefits of epiduroscopy after weighing the risks for individual patients with FBSS.