Efficacy of Epidural Adhesiolysis in the Treatment of Lumbar Post-surgery Syndrome: A Case Report on Six Patients

Abstract

Aims: Lumbar post-surgery syndrome (LPSS) can cause persistent low back pain after lumbar surgery, and epidural fibrosis is a recognised contributor to ongoing radicular symptoms and functional limitation. This case report describes short-term pain and functional outcomes after fluoroscopy-guided percutaneous epidural adhesiolysis (Racz procedure) in six patients with refractory LPSS. Presentation of Case: Six patients with chronic low back pain after previous lumbar decompression, stabilisation, or fusion procedures were treated at our institution. Eligibility required symptoms for at least six months, inadequate response to at least three months of conservative management, and magnetic resonance imaging evidence of epidural fibrosis or adhesions. The cohort comprised three men and three women, with a mean age of 59.3 years (range, 52-67 years). Outcomes were assessed before the procedure and at three months using the Visual Analogue Scale (VAS), Roland Morris Disability Questionnaire (RDQ), and Oswestry Disability Index (ODI). Mean VAS decreased from 8.0 to 3.0, mean RDQ from 18.2 to 7.5, and mean ODI from 66.0% to 25.3%. No complication was documented. Discussion: Improvement may have reflected mechanical disruption of adhesions, improved epidural medication spread, dilution of inflammatory mediators, enzymatic degradation of scar-related matrix, and targeted delivery of local anaesthetic and corticosteroid to symptomatic nerve roots. Conclusion: Epidural adhesiolysis was associated with short-term reductions in pain and disability in selected patients with LPSS who had not responded adequately to conservative treatment. Longer follow-up and controlled evaluation are required to define durability and patient selection more clearly.