# Retrospective Cohort Study of 221 Cases of Epidural Per-Cutaneous Peri-Neural Release (Adhesiolysis)

## TL;DR

This study shows that a modified epidural procedure called PNR significantly reduces pain and improves quality of life for patients with lower back and limb pain from spinal disc issues.

## Contribution

The study introduces Peri-Neural Release (PNR) as a modified epidural adhesiolysis technique and demonstrates its effectiveness in treating radicular syndromes.

## Key findings

- PNR significantly improved pain scores and quality of life measures (EQ-5D) with no major complications.
- Patients experienced a notable decrease in pain (NRS from 7.9 to 3.1) and increased pain-free activity duration.
- Most complications were minor and self-resolving, such as lower limb numbness and coccydynia.

## Abstract

Background: Lower limb (LL) and low back Radicular Syndromes (RSs) may result from discopathy of the lumbo-sacral spine. Consistent benefits are reported from Epidural Adhesiolysis (EA). Aim: To evaluate clinical and European Quality of Life items (EQ-5D) of Peri-Neural Release interventions (PNR, a modified approach and terminology for EA) among patients diagnosed with lumbo-sacral discopathy associated radicular syndromes. Methods: A retrospective study was conducted by retrieving records of patients e treated by PNR for low back and lower limbs pain between January 2018 and December 2024. Eligible patients were adults who were diagnosed with lumbo-sacral discopathy, stenosis, or Post Lumbar Surgery Syndrome (PLSS). Data on Patient-Reported Outcome Measures (PROMs) adopting the European Quality of Life five items (Euro-QoL 5D) that includes self-ratings of mobility, active daily living, self-care, pain and discomfort, anxiety and depression) was collected before the procedure and on subsequent follow-up visits. Other clinical outcomes included numerical pain rating scales (NRSs), sleep quality, time to pain during activity, and self-reported health scores. Results: A total of 221 patients were included in this analysis. Of these, 56.6% were female, with a mean age of 45.1 ± 14.7 years. In total, 50.2% of patients underwent PNR alone, followed by 28.1% who underwent PNR balloon decompression neuroplasty. Of the remaining patients, 7.2% underwent epiduroscopic PNR, 6.3% PNR combined with annuloplasty (biacuplasty) and 8.1% underwent PNR combined with nucleoplasty. Significant improvements were observed across all EQ-5D and NRS (p < 0.001) at follow-up assessments without major complications. The interventions were associated with a decrease in NRS from 7.9 to 3.1, and an increase in the duration of pain-free activity (walking, standing, sitting) (p < 0.001). Self-reported overall health scores improved from 53.9 ± 18.4 to 81.1 ± 15.1. In terms of complications, two patients reported post-operative headache. The remaining side effects included coccydynia at the site of intervention, resolving with application of non-steroid anti-inflammatory topicals and self-resolving lower limb numbness in five cases. Conclusions: The presented data suggest that PNR—whether performed alone or in combination with adjunctive intradiscal procedures—is a safe intervention, and is associated, in the majority of patients, with substantial pain relief and improvement in EQ-5D both in the short- and long-term follow-up.