DESCRIPTION
Percutaneous epidural lysis of adhesions (also referred to as epidural neuroplasty or epidural adhesiolysis) has been investigated as a procedure to reduce or eliminate adhesions, fibrosis, or scars. Injection of contrast dye, local anesthetic, corticosteroid, or an injection of an irritating solution, often 10% hypertonic sodium chloride, is administered through a catheter placed in the epidural space over 1-3 days. Side effects commonly seen are headaches, burning lumbar pain radiating unilaterally or bilaterally down the legs, and low-grade fever. This procedure can also cause adhesive arachnoiditis.
Another approach to lysing of epidural adhesions is epiduroscopy. Epiduroscopy is a new method being investigated to directly visualize and treat the inside of the spinal column. A small flexible fiberoptic catheter is inserted through a tiny incision and the areas of concern can be seen on a video monitor. It has been proposed that adhesions or scar tissue can be treated using this technique.
POLICY
Lysis of epidural adhesions for chronic pain syndrome is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Controlled studies were not found in the published literature that provides comparisons of epidural adhesiolysis for chronic pain syndrome to other techniques. No evidence was found to show that epidural adhesiolysis for chronic pain syndrome can predict clinical events and, thus, be used to alter the treatment of individuals.
SOURCES
BlueCross Blue Shield Association. Medical Policy Reference Manual. (2:2009). Lysis of epidural adhesions (8.01.18). Retrieved March 11, 2010 from BlueWeb. (23 articles and/or guidelines reviewed)
Boswell, M. V., Trescot, A. M., Datta, S., Schultx, D. M., Hansen, H. C., Abdi, S., et al. (2007). Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician, 10 (1), 7 - 111. (1,334 articles and/or guidelines reviewed)
Manchikanti, L., Boswell, M., Singh, V., Benyamin, R., Fellows, B., Abdi, S., et al. (2009). Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 12(4), 699 - 802. (1082 articles and/or guidelines reviewed)
Manchikanti, L. Singh, V., Cash, K., Pampati, V., & Datta, S. (2009). A compariative effectiveness evaluation of percutaneous adhesiolysis and epidural stereoid injections in managing lumbar post surgery syndrome: a randomized equivalence controlled trial. Pain Physician, 12 (6), E 355 - 368. (Level 2 Evidence)
Manchikanti, L., Cash, K., McManus, C., Pampati, V., Singh, V., & Benyamin, R. (2009). The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial. Pain Physician, 12 (6), E 341 - 345. (Level 2 Evidence)
National Guideline Clearinghouse. American Society of Interventional Pain Physicians. (2009). Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Retrieved January 15, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15136&string=lysis+AND+epidural+AND+adhesions.
National Institute for Health and Clinical Excellence. (2010, February). Therapeutic endoscopic division of epidural adhesions. Retrieved March 11, 2010 from http://www.nice.org.uk/nicemedia/pdf/IPG333Guidance.pdf.
Trescot, A. M., Pradeep, C., Abdi, S., Datta, S., & Schultz, D. (2007). Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update. Pain Physician, 10 (1), 129 - 146. (Level 2 Evidence)
ORIGINAL EFFECTIVE DATE: 6/1998
MOST RECENT REVIEW DATE: 4/8/2010
ID_BA
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