Value of Hyaluronidasein Steroid Caudal Epidural Injection with High Volume Normal Saline for Failed Back Syndrome

Background: Management of low back pain after spinal surgeries is one of the most challenging problems in pain medicine. Re-surgery must be considered, however, re-surgery is complex and costly. The rationale for use of hyaluronidase in patients with failed back syndrome (FBS) relies upon its reported ability to disrupt epidural adhesions. Objective: Evaluate the efficacy of adding hyaluronic acid to steroids and high volume normal saline by caudal epidural injection. Patients Methods: Forty patients with failed back syndrome after lumber spinal surgery were included in this prospective randomized study to evaluate the efficacy of adding hyaluronic acid to steroids by caudal epidural injection of high volume saline. Group A was injected with local anesthetics and steroids only while in group B, hyaluronidase was added. Results: Group A included fifteen males (75 %) and five females (25%). The mean age was forty years with a range of twenty four to twenty nine. In group B, there were fourteen males (70 %) and six females (30 %). The mean age was thirty eight with a range of 27 to 60. The mean body mass index (BMI) was 26.75 with a range of 24 to 30 for Group A, while it was 26.6 with a range of 24 to 29 in group B. The mean duration of symptoms in group A was seven and half months with a range of 3 to16 months while in group B the mean duration of symptoms was 8.2 months with a range of 2 to 18 months. In our study there was improvement of Visual analogue scale (VAS) in both groups at one month and six months however the mean VAS was higher in Group B than Group A. In group A the mean VAS decreased from 7.5 before the procedure to 3.15 and 1.89 at one month and after six months post procedure respectively. In group B the mean VAS decreased from 7.6 before the procedure to2.25and 1.5 at one month and after six months post procedure. Conclusion: Addition of hyaluronidase increases efficacy of epidural injection by decreasing pain on the short and long term. It increases patient satisfaction and is safe with minimal adverse effect.