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

Percutaneous epidural neuroplasty (epidural neurolysis, lysis of epidural adhesions) is an interventional pain management technique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. In addition to local anesthetic and corticosteroid, hypertonic saline (10% NaCl) and hyaluronidase are used for the technique. The objective of this study was to determine if hypertonic saline or hyaluronidase influenced treatment outcomes.

Eighty-three subjects with radiculopathy plus low back pain were assigned to one of four epidural neuroplasty treatment groups: (a) hypertonic saline plus hyaluronidase, (b) hypertonic saline, (b) isotonic saline (0.9% NaCl), or (d) isotonic saline plus hyaluronidase. Subjects in all treatment groups received epidural corticosteroid and local anesthetic.

Twenty-four subjects did not complete the study. Most of the other 59 subjects receiving any of the four treatments as part of their pain management obtained significant relief immediately after treatment. Visual analog scale (VAS) scores for the area of maximal pain (VASmax; back or leg) were reduced in 25% or more of subjects in all treatment groups at all post-treatment follow-up times (1, 3, 6, 9, and 12 months). A smaller fraction of subjects treated with hypertonic saline or hyaluronidase and hypertonic saline required more additional treatments than did subjects receiving the other treatments.

Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for over one year) in 25% or more of subjects with radiculopathy plus low back pain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.