FAQs on Epidural Adhesiolysis in Colorado

 

Adhesiolysis is epidural lysis of adhesions. The procedure is derived from the words “adhesion,” which means scar tissue, and “lysis,” which means to destroy or dissolved. The epidural adhesiolysis procedure is a minimally-invasive technique proven effective for treating neck and back pain due to scar formation.

What is the purpose of the epidural adhesiolysis procedure?

Scar tissue can form around nerve roots, which leads to constant, severe pain. Adhesions form due to irritation and inflammation in the epidural space. When adhesions aggravate nearby nerve roots, it leads to intense discomfort. The epidural adhesiolysis procedure is used to remove scar tissue in the neck or back region.

What conditions are associated with scar tissue in the epidural space?

Depending on the patient, back pain due to adhesions occurs from many causes. Some of these include:

  • Failed back surgery syndrome
  • Frequent epidural steroid injections
  • Lumbar stenosis
  • Lumbar radiculopathy

How do I prepare for the procedure?

The pain management specialist will order and review a magnetic resonance imaging (MRI) scan to identify is the nerves are affected by scar tissue. After a series of epidural steroid injections to treat your pain, the doctor will determine if or not removing the scar tissue can help. Before your procedure is scheduled, the doctor will ask questions about your symptoms, take a detailed medical history, and conduct a comprehensive examination. You should tell the doctor about all medicines you take, arrange for someone to drive you home, and wear loose-fitting clothing to your appointment.

How is the epidural adhesiolysis procedure done?

When you arrive to your appointment, a nurse had you fill out paperwork, instructs you to change into a gown, and places an intravenous catheter in your arm. You are positioned face-down on the table, and a mild sedative is given. The skin is cleaned and numbed, and the procedure catheter/guide wire is placed into the epidural space using real-time x-ray. Once the catheter is in the right position, medications are injected to dissolve the scar tissue and reduce irritation and inflammation. After the procedure, the needle catheter is removed, and a bandage is applied.

What medications are used?

During the epidural adhesiolysis procedure, medications used include a corticosteroid (triamcinolone or dexamethasone), an anesthetic (bupivacaine or lidocaine), hypertonic saline, omnipaque, and hyaluronidase.

What can I expect after the epidural adhesiolysis procedure?

After the epidural adhesiolysis procedure, expect to have some soreness at the needle insertion site. You should rest for 1-2 days, and slowly return to usual activities. The steroid begins to work after 48-72 hours, so discomfort is relieved. The procedure is designed to dissolve scar tissue, and research studies show it offers long-term effectiveness of epidural lysis of adhesions.

Does epidural adhesiolysis work?

According to the American Society of Interventional Pain Physicians, the epidural adhesiolysis procedure works well for long-term pain control in radiculopathy and refractory pain. In a large study, 100% of patients treated had pain relief, which was long-term. The patients stated that they decreased use of pain medicines and enjoyed improved functional status and overall mental health. In another study involving 234 patients with failed back surgery syndrome, mechanical removal of adhesions improved pain scores and functional status in all patients at the 48-month follow-up.

Resources

Chun-jing H, Hao-xiong N, Jia-xiang N. The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome. Acta Cir Bras. 2012; 27(4):357-362.

Donato A, Fontana C, Pinto R et al. The effectiveness of endoscopic epidurolysis in treatment of degenerative chronic low back pain: a prospective analysis and follow-up at 48 months. Acta Neurochir Suppl. 2011; 108:67-73.

Manchikanti L, Singh V, Cash KA, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial. J Pain Res. 2012; 5:597-608.