Percutaneous epidural neuroplasty: Prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase

Background and Objectives. Percutaneous epidural neuroplasty (epidural neur olysis, lysis of epidural adhesions) is an interventional pain management t echnique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. L n addition to local anesthetic and corticosteroid, hypertonic saline (10% N aCl) and hyaluronidase are used for the technique. The objective of this st udy was to determine if hypertonic saline or hyaluronidase influenced treat ment outcomes. Methods. Eighty-three subjects with radiculopathy plus low b ack pain were assigned to one of four epidural neuroplasty treatment groups : (a) hypertonic saline plus hyaluronidase, (b) hypertonic saline, (b) isot onic saline (0.9% NaCl), or (d) isotonic saline plus hyaluronidase. Subject s in all treatment groups received epidural corticosteroid and local anesth etic. Results. Twenty-four subjects did not complete the study. Most of the other 59 subjects receiving any of the four treatments as part of their pa in management obtained significant relief immediately after treatment. Visu al analog scale (VAS) scores for the area of maximal pain (VAS(max); back o r leg) were reduced in 25% or more of subjects in all treatment groups at a ll post-treatment follow-up times (1, 3, 6, 9, and 12 months). A smaller fr action of subjects treated with hypertonic saline or hyaluronidase and hype rtonic saline required more additional treatments than did subjects receivi ng the other treatments. Conclusions. Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for o ver one year) in 25% or more of subjects with radiculopathy plus low back p ain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.