Aplikace hyázy v léčbě pooperační epidurálnífibrózy – zkušenosti s léčbou 100 nemocných

Administration of Hyaluronidase in the Treatment of Postoperative Epidural Fibrosis: Results ofTreatment of 100 Patients

Objective:
Postoperative epidural fibrosis, being a part of failed back surgery syndrome (FBSS), is a frequent sequelae oflumbar disc surgery which is difficult to treat. The second surgery does not yield good results.No single treatment modalityof epidural fibrosis achieves good results. This is the reason for trying of new approaches to its treatment.Design: Retrospective, observational questionnaire based study.Setting: Department of Neurosurgery, Central Military Hospital, Praha.Material and methods: We studied a cohort of the first epidural administration of hyaluronidase to 100 patients with historyof one or more lumbar disc surgeries and residual pain typical for epidural fibrosis.Results: In the follow-up period of more than 12 months after administration of hyaluronidase, VAS improved by 1 to 3 pointsin 16% of patients, 3 to 5 points in 30 % of patients and more than 6 points in 21 % of patients. In 25 % of patients the painintensity did not improve, in 10% even deteriorated.Conclusion: The efficacy of hyaluronidase treatment itself is a proof of clinical importance of epidural fibrosis. Epiduraladministration of hyaluronidase is one of the least invasive treatment modalities of epidural fibrosis. The potential for itspositive effect in the treatment of FBSS should not be neglected even though it could not be seen in all cases.

Key words:
epidural fibrosis – failed back surgery syndrome (FBSS) – hyaluronidase – epidural administration