Lysis of epidural adhesion

Lysis of epidural adhesion

After back surgery or a serious injury affecting the spine, adhesions (bands of fibrous scar tissue) naturally develop in the epidural space as part of the normal healing process. The epidural space is the area between the spinal cord and the vertebral bones that surround it. When in excess, this scar tissue may compress the nerves and restrict their movement, causing inflammation and pain.

Lysis of adhesions is an outpatient procedure performed to decrease the amount of scar tissue (or remove it completely), which releases tension on the nerves and thus relieves pain. This is a procedure Dr. Sonia Pasi offers to her patients at Advanced Pain Consultants. It involves the use of a specialized catheter to inject various medications into the epidural space to dissolve or physically break-down the epidural adhesions. The exact combination of drugs can vary, but most often used is a steroid to reduce inflammation around the nerves, a chemical enzyme (hyaluronidase) to dissolve the adhesions, and a local anesthetic. Lysis of adhesions is a safe, effective and proven method for pain relief.

Candidates

Epidural lysis of adhesions is most often used with patients who have persistent lower back and leg pain due to epidural adhesions following lumber (lower) spine surgery or an injury. Symptoms of epidural lesions include lower back pain (typically a constant, burning pain), radicular pain (such as sciatica which shoots from the spine into the thighs, calves or feet), muscle spasms, motor/sensory or reflex changes, and limited mobility in the thighs and calves.

In addition to treating excessive scarring, this procedure can be used to treat a range of other back and spine conditions, including:

  • Herniated or prolapsed intervertebral discs (especially when not surgically correctable).
  • Metastatic carcinoma of the spine (leading to compression fracture).
  • Degenerative spondylosis (affecting multiple levels of the spine).
  • Spinal (back) stenosis (a narrowing of the open spaces within the spine).
  • Cervical (neck) stenosis.
  • Post-laminectomy syndrome (failed back surgery syndrome).
  • Degenerative arthritis of the spine.
  • Occipital neuralgia.

Epidural lysis of adhesions is not a “first line” treatment. Generally patients who undergo this therapy have tried more conservative treatment options (such as medications and epidural steroid injections), which have failed to relieve their pain.

Procedure

Lysis of adhesion is performed in our office or an outpatient surgery center, with the patient under local anesthesia. The procedure generally takes around 30 to 60 minutes. Dr. Pasi starts by cleansing the patient’s lower back with antiseptic solution before injecting a numbing medication. After the numbing medication has taken effect, she will make a small incision. Then, using a fluoroscope (a special x-ray machine with real-time imaging) for guidance, she will insert a catheter through the incision and into the area inside the epidural space that is suspected of causing pain. Dr. Pasi may inject a small amount of dye to confirm the correct exact location of the catheter.

After reaching and confirming the affected area, the catheter is then used to inject the mixture of medications into the treatment area, which will help dissolve the adhesions (scar tissue) and reduce edema (swelling), to relieve pain. Dr. Pasi may also mechanically agitate the area with the catheter, to help break up scar tissue. The entire time, the movement of the catheter is monitored with the fluoroscope to ensure safe and accurate positioning. Once all the injections have been administered, the catheter is removed, and the incision area is cleansed and bandaged.

After the procedure, patients are observed for a short amount of time in the recovery area before being discharged to go home. Patients may experience some mild numbness or heaviness in their legs following the procedure, but this normally lasts no more than 24 hour. Normal routines can generally be resumed the next day.

Results

The vast majority of people who undergo epidural lysis of adhesions experience significant improvement in physical health, mobility and psychological well-being. Relief is not immediate though; it can take several days and up to two weeks before the injection takes effect. The level of relief varies from patient to patient, but most experience pain relief lasting for 2 to 3 months. Physical therapy can help sustain improvement after the procedure.

In some cases, one treatment may not relieve the patient’s symptoms. If two weeks have passed since the injection and there is no pain relief, a second treatment may be recommended. If that one does not bring relief after two weeks, a third procedure may be recommended. The effects of the injections are additive if spaced at these time intervals. One caveat: We do not recommend performing more than three steroid injections in a six-month time period (any more than three can cause serious side effects). If, two weeks have passed after the third injection and there is no pain relief, a fourth would not be recommended as it doubtful that any additional treatments would be beneficial.

For more information

If you have persistent, nagging back or neck pain following surgery, don’t suffer any longer. Please call Advanced Pain Consultants at (919) 510-7901 to schedule your evaluation with Dr. Pasi. After determining the cause of your pain, she may use a variety of treatments to provide you with pain relief. If you have excessive scarring, that could include epidural lysis of adhesions or a combination of therapies. Dr. Pasi is ready to help. The first step to feeling better is to make your appointment.