脊椎術後疼痛症候群以神經解離治療的結果2010年以後的系統性研究回顧

Neurolysis outcome for Failed back surgery syndrome_systemic research review after 2010

Failed back surgery syndrome (FBSS) defined as back pain not resolving to a satisfying level or a new back pain after spinal surgery. The scarring and adhesion in epidural space was considered lead to inflammation then this persisted inflammatory process may rise to more adhesion around nerve roots. So this vicious cycle is hard to break even after another surgery. Epidural injection or another surgery may be considered for those who suffered from persisted pain after conservative treatments. Except the above treatments, percutaneous epidural adhesiolysis (PEA) is one of the well-known options nowadays. By using Racz catheter to mechanically lysis adhesion and/or injecting medications such as steroids, saline, local anesthetics or hyaluronidase into epidural space to reduce inflammatory process, PEA can be an effective procedure to relief low back pain with low complication rate. Three randomized controlled trials and 1 observational study were included in this systemic review of PEA in treating low back pain due to FBSS. All of them showed positive results for pain relief and life quality improvement to 6 months after PEA. Besides, the complication rate was low and those complications were mostly self-limited. This review provides good evidence on effectiveness and safety of PEA in dealing with chronic low back pain due to FBSS.

脊椎手術後疼痛症候群（Failed back surgery syndrome）指的是在脊椎手術後疼痛不如預期的緩解，或是再次出現疼痛的問題。手術後的疤痕及沾黏造成硬脊膜外腔的發炎，而發炎的過程中又會導致更多的沾黏形成，即使是再次進行手術也難以打破這個惡性循環。通常這群病人在接受保守治療後，可以進行硬脊膜外腔的注射或是再次手術，而近來發展出的經皮硬脊膜外腔沾黏解離術（Percutaneous epidural adhesiolysis）可以是另一種選擇。經皮硬脊膜外腔沾黏解離術使用特製的Racz導管來破壞沾黏的組織，並在硬脊膜外腔注射類固醇、局部麻醉劑、食鹽水、或透明質酸酶以降低發炎的反應。這個方式能有效降低病人的下背痛，而且只有很低的併發症發生率。這篇系統性文獻回顧評估了三篇隨機分派臨床試驗及一篇觀察性研究，發現在實行經皮硬脊膜外腔沾黏解離術的六個月後，病人的疼痛指數降低、生活品質提升，跟實行硬脊膜外腔注射的病人比起來有顯著的差異。除此之外，併發症的發生率及嚴重度不高，且通常都有自限性。在脊椎手術後疼痛症候群的病人身上，經皮硬脊膜外腔沾黏解離術會是一個有效又安全的處置。