1. 2013;16;SE125-SE150Spinal Endoscopic Adhesiolysis in Post Lumbar Surgery Syndrome: An Update of Assessment of Evidence
   Systematic Review
   Standiford Helm II, MD, Salim M. Hayek, MD, PhD, James Colson, MD, Pradeep Chopra, MD, Timothy R. Deer, MD, Rafael Justiz, MD, Mariam Hameed, MD, and Frank J.E. Falco, MD.

BACKGROUND: Post lumbar surgery syndrome refers to pain occurring or present after lumbar surgery. While the causes of pain after lumbar surgery are multi-factorial, scarring is a significant source of that pain. Low back and/or leg pain after lumbar surgery can persist despite appropriate conservative therapy. Spinal endoscopy allows direct visual evaluation of the epidural space, along with mechanical lysis of any adhesions present.
STUDY DESIGN: A systematic review of the effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome.
OBJECTIVE: To evaluate and update the effectiveness of spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome.
METHODS:  The available literature on spinal endoscopic adhesiolysis in treating post lumbar surgery syndrome was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies.
The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles.
OUTCOME MEASURES: Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, opioid intake, and return to work.
Short-term effectiveness was defined as improvement of 12 months or less; whereas, long-term effectiveness was defined 12 months or longer.
RESULTS: For this systematic review, 21 studies were identified. Of these, one randomized controlled trial (RCT) and 5 observational studies met the inclusion criteria. Two of the observational studies were excluded because of other methodological issues, despite showing positive outcomes.
Using current criteria for successful outcomes, these studies indicate that there is fair evidence for the effectiveness of spinal endoscopy in the treatment of persistent low back and/or leg pain in post lumbar surgery syndrome.
LIMITATIONS:  The limitations of this systematic review include the paucity of literature.
CONCLUSIONS: The evidence is fair that spinal endoscopy is effective in the treatment of post lumbar surgery syndrome.