Seven studies were included in the effectiveness analysis: five RCTs (403 patients) and two observational studies (127 patients). High drop-out rates were reported in several studies. Three of the included randomised trials allowed participants to cross-over treatment at a given time point (three months). Follow-up was up to 12 months.
All studies that met eligibility criteria were considered to be clinically relevant. Four of the five RCTs were high quality and one was moderate quality. The two cohort studies were moderate quality; one cohort study that met inclusion criteria was deemed to be of poor quality and excluded from the effectiveness analysis.
Three high quality RCTs were reported to show significant (greater than 50%) pain relief with adhesiolysis for treatment of chronic low back and leg pain due to post lumbar surgery syndrome. However, it was difficult to interpret the results for one of the RCTs as evidence tables reported inconsistent findings; one table suggested significant improvement and the other showed no difference in outcomes. This evidence was graded by the authors as fair according to US Preventative Services Task Force criteria.
One high quality RCT and one moderate quality cohort study found significant improvement in pain relief with adhesiolysis in the treatment of chronic low back pain and leg pain due to spinal stenosis. This evidence was graded by the authors as fair according to US Preventative Services Task Force criteria.
Complications of percutaneous epidural adhesiolysis were reported but were not included in this summary as it appeared that additional studies that did not meet the review eligibility criteria were included in these results.