DOI: 10.4103/ijpn.ijpn_210_25 ISSN: 0970-5333

Comparative Study in Percutaneous Adhesiolysis with Isotonic Saline versus Hypertonic Saline in Management of Failed Back Surgery Syndrome

R. Harivignesh, Sheezan Perwez, Pranesh Mondal, Vasundhara Ghosal, Firdaus Kamal, Rajesh Pramanik
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Introduction:

The presence of adhesions around the nerve roots is one of the major reasons for failure of spinal surgery. Percutaneous adhesiolysis is an interventional pain management technique that has emerged in recent years in treating failed back surgery syndrome (FBSS). The role of corticosteroids and hyaluronidase has been extensively studied. Hypertonic and isotonic saline (IS) are being used in the procedure, but their differences have not been studied in detail.

Aims and Objectives:

The aim and objective of this study was to determine the effectiveness of percutaneous adhesiolysis and the effect of hypertonic saline (HS) in this procedure by comparing with IS.

Materials and Methods:

Parallel group, single blind, randomized controlled trial done with 72 patients selected from the outpatient department in a tertiary care center with FBSS, Visual Analog Scale (VAS) >5, and excluding patients with neurodeficit or any contraindication to the procedure. Randomized into two groups – Percutaneous adhesiolysis with HS and IS. Parameters were VAS for pain and Oswestry Disability Index for disability taken at preintervention, 2-, 4-, and 12-week post-intervention.

Results:

Excluding the dropouts ( n = 5), analysis was done. Both groups showed significant pain reduction and disability reduction up to 12 weeks of follow-up with minimal adverse effects. On comparison between the groups, HS group had better improvement in pain and disability than that of IS group ( P = 0.0302, 0.0024).

Conclusion:

Percutaneous adhesiolysis provides pain and disability reduction in FBSS refractory to conservative management. The use of HS offers better pain and disability reduction than that of IS.

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