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The following is a summary of “Endoscopic Epidurolysis for the Management of Chronic Spinal Pain: A Delphi-Based Italian Experts Consensus,” published in the December 2024 issue of Pain by Leoni et al.
Endoscopic epidurolysis (EE) was a minimally invasive procedure used to manage chronic spinal pain, but comprehensive guidelines on its optimal use were lacking in the literature.
Researchers conducted a retrospective study using a modified Delphi approach to collect expert consensus on best practices for EE within the Italian pain therapy network.
They performed an extensive literature review to identify key topics for investigation, such as clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was created and distributed to a panel of experts. A two-round Delphi process was used, with consensus described as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements lacking consensus in the first round were rephrased and reintroduced in the second round.
The results showed that 26 clinicians participated, with a 100% response rate in both rounds. Consensus was reached on 9 out of 19 statements in the first round and 8 out of 10 rephrased statements in the second round. Key areas of agreement included clinical indications for EE, the significance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, no consensus was reached regarding the EE usage for disc herniation with radicular pain or the safety of interlaminar access compared to sacral hiatus access.
Investigators concluded the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain.
Source: link.springer.com/article/10.1007/s40122-024-00695-2
