[Epidurolysis - an old-new procedure].

Abstract

Epidural adhesions may be caused by inflammation of the surrounding spinal canal, disc degeneration (nucleus pulposus entering the epidural space as a result of damage to the disc), or scarring following spinal surgery (failed back surgery). The roots become stuck due to adhesions, which hinder their mobility. Furthermore, the richly innervated posterior longitudinal ligament and the dura mater are inhibited from “sliding” on each other. These patients develop chronic radicular and/or low back pain. The range of conservative treatments available is often limited, and the quality of life of patients is frequently impaired by severe pain and neurological deficits. Our goal is to introduce a cost-effective, minimally invasive therapeutic option in Hungarian public hospitals which can serve as a long-term solution for the treatment of the above-mentioned medical conditions. In our case report, we present epidurolysis as an innovative therapeutic option, which can be effectively used in the treatment of epidural adhesions. The 71-year-old lady underwent LIV–V flavotomy and discectomy in 2019. However, despite this intervention, the excruciating pain radiating to the left lower limb persisted. Based on the subsequent MRI of the lumbar spine and the physical examination, scarring was assumed around the previous surgical area, so lumbar epidurolysis was performed according to the one-day protocol. The patient reported a notable reduction in pain levels both immediately following the intervention and at the 6-week follow-up, with no requirement for the use of painkillers. The rationale for epidurolysis in postlaminectomy syndrome is level I evidence, and for the treatment of spinal pain due to disc herniation and spinal canal stenosis with or without radicular pain is level II evidence. Epidurolysis is a highly effective, safe and cost-effective procedure in experienced hands, especially when its social effects are taken into account. Orv Hetil. 2025; 166(6): 234–240.