Endoscopic Epidurolysis for the Management of Chronic Spinal Pain: A Delphi-Based Italian Experts Consensus.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2025-02-01 Epub Date: 2024-12-20 DOI:10.1007/s40122-024-00695-2

Matteo Luigi Giuseppe Leoni, Felice Occhigrossi, Michael Tenti, William Raffaeli

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Abstract

Introduction: Endoscopic epidurolysis (EE) is a minimally invasive procedure used to manage chronic spinal pain, particularly in cases unresponsive to traditional treatments. Despite its growing recognition, the literature lacks comprehensive guidelines on its optimal use. This study utilized a modified Delphi approach to gather expert consensus on best practices for EE in the Italian pain therapy network.

Methods: The study's scientific board conducted an extensive literature review to define key investigation topics, including clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was developed and administered to a panel of experts. A two-round Delphi process was implemented, with consensus defined as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements that did not reach consensus in the first round were rephrased and resubmitted in the second round.

Results: Twenty-six clinicians participated in the study, with a 100% response rate in both rounds. In the first round, consensus was achieved for 9 out of 19 statements. In the second round, 8 out of 10 rephrased statements reached the consensus threshold. Key areas of agreement included the clinical indications for EE, the importance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, consensus was not reached on the use of EE for disc herniation with radicular pain and the safety of interlaminar access compared to sacral hiatus access.

Conclusion: The study highlights the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain. The consensus reached by the expert panel provides a framework for best practices, which can guide clinical decision-making and improve patient outcomes. Further research is necessary to validate these findings and address areas where consensus was not achieved.

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内窥镜表皮剥脱术治疗慢性脊柱疼痛：基于德尔菲法的意大利专家共识。

内镜下硬膜外膜松解术（EE）是一种微创手术，用于治疗慢性脊柱疼痛，特别是在传统治疗无效的情况下。尽管越来越多的人认识到，文献缺乏全面的指导方针，其最佳使用。本研究利用改进的德尔菲法收集意大利疼痛治疗网络中情感表达最佳实践的专家共识。方法：该研究的科学委员会进行了广泛的文献综述，以确定关键的研究主题，包括临床适应症、术前评估和情感表达的技术方面。制定了一份半结构化的调查问卷，并向专家小组进行了管理。实施了两轮德尔菲过程，共识定义为在7分李克特量表上至少70%的同意（同意或非常同意）。在第一轮中未达成协商一致意见的发言在第二轮中重新措辞并重新提交。结果：26名临床医生参与了这项研究，两轮的有效率均为100%。在第一轮中，19项发言中有9项达成共识。在第二轮中，10个重新措辞的发言中有8个达到了协商一致的门槛。达成一致的关键领域包括EE的临床适应症、术前成像和麻醉评估的重要性，以及EE的特定技术和工具的使用。然而，对于使用EE治疗伴有神经根性疼痛的椎间盘突出症，以及与骶裂孔入路相比椎间入路的安全性，尚未达成共识。结论：该研究强调了EE标准化方案的必要性，以确保慢性脊柱疼痛的一致和有效治疗。专家小组达成的共识为最佳实践提供了一个框架，可以指导临床决策并改善患者预后。需要进一步的研究来验证这些发现，并解决尚未达成共识的领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.