Comparison of the Effectiveness of Epidural Lysis of Adhesions by Caudal Catheter Insertion or Transforaminal Epidural Lysis at the L5-S1 Level for Failed Back Surgery Syndrome Treatment.

BACKGROUND: Despite multiple studies suggesting the significant benefits of epidural lysis for failed back surgery syndrome (FBSS), comparative evaluations with different approaches of epidural lysis remain limited. The present study aims to investigate the efficacy of caudal catheter-based epidural lysis of adhesions techniques versus transforaminal epidural lysis in treating pain and disability after L5-S1 lumbar surgery. METHODS: This study was a double-blinded randomized clinical trial conducted on patients diagnosed with FBSS after lumbar spine surgery at the level of L5-S1 and complained of pain for more than 3 months. These patients who were referred to the Imam Reza Hospital pain clinic in Mashhad, Iran, in 2023, were randomly assigned to one of two groups: one undergoing caudal epidural lysis of adhesions with a catheter, and the other received L5-S1 transforaminal epidural lysis. The intensity of patients' pain and their motor and sensory function were evaluated before intervention and 4 weeks, and 12 weeks post-intervention. Outcomes were compared within and between the two groups using the Numerical Rating Scale (NRS) and the Oswestry Disability Index (ODI) questionnaire to assess their functional status. RESULTS: During follow-up, the ODI, back NRS, and leg NRS scores were significantly lower in patients who underwent epidural lysis with catheter compared to the transforaminal group ( P < 0.05). The caudal catheter group showed success rates of ODI, back NRS, and leg NRS factors among 73.5%, 79.4%, and 70.6% of patients, respectively. The transforaminal lysis group was successful in 54.5%, 48.5%, and 48.5% of patients in terms of ODI, back NRS, and leg NRS factors, respectively. Additionally, at the 12-week follow-up, the rate of treatment success in terms of ODI (χ 2 = 4.53, P = 0.02) and back NRS (χ 2 = 5.78, P = 0.01) was significantly higher in the caudal lysis group compared to the transforaminal lysis group. However, no significant difference was observed in leg NRS outcomes at 12 weeks after treatment (χ 2 = 0.25, P = 0.109). CONCLUSION: In conclusion, this study indicates that caudal epidural lysis with a catheter is more effective than transforaminal lysis in terms of pain reduction and functional improvement for patients with L5-S1 level FBSS.