FAQs on Adhesiolysis Treatment in Philadelphia

Adhesiolysis, also called epidural lysis of adhesions, is a minimally invasive procedure designed to stop spinal pain with associated radiculopathy. The intervention involves dissolving scar tissue (epidural adhesions) that form around nerve roots.

What do epidural adhesions do?

Epidural adhesions often form after back surgery. They also result from disc material leaking into the epidural space following long-term inflammation or a tear in the outer disc layer (annulus).

How do epidural adhesions cause chronic back pain?

Epidural adhesions interfered with certain therapeutic procedures, such as an epidural steroid injection (ESI). The goal of adhesiolysis is to remove scar tissue so medications can flow through the epidural space.

Is adhesiolysis effective?

In a large review of randomized controlled studies, researchers found that adhesiolysis is an effective therapy for the treatment of chronic refractory back pain with radiculopathy. In another study, the success rate of the procedure was 76%, with patients reporting a 50% reduction in pain.

What can I expect before the adhesiolysis procedure?

When you arrive at the medical facility, a nurse will discuss the risks and benefits of the procedure with you. Once you sign a consent form, an IV is placed in your arm for necessary fluids and medications. The doctor may give you a mild sedative, so be sure to have someone to drive you home.

What happens during the adhesiolysis procedure?

During the procedure, the patient first receives an injection of a local anesthetic into the skin and deeper tissues of the lower back. Once the area is numbed, the doctor will advance a hollow needle and catheter into the epidural space using diagnostic imaging to assure correct placement. The medications are injected through the catheter to dissolve the adhesions, reduce inflammation, and relieve irritated tissues. Once this process is completed, the catheter is removed, and a bandage is applied.

What medications are used in this procedure?

The doctor can use hypertonic saline, omnipaque, anesthetics, hyaluronidase, corticosteroids, or a combination of these.

What happens after the adhesiolysis procedure?

Right after the procedure, you will be moved to a recovery area. A nurse will monitor you for around 20-30 minutes to assure your vital signs are stable. The doctor will ask you questions about your pain. To reduce the risk of infection, the doctor will give you antibiotics to take. You will be given discharge instructions. You are not allowed to return to heavy lifting and work for a few days, and will need to rest the remainder of the day.

What are the benefits of the procedure?

Adhesiolysis of scar tissue is safe, cost-effective, and beneficial for pain relief. In one study, the success rate was found to be 93% initially, and results for many patients lasted for up to a year.

What risks and complications are associated with the adhesiolysis procedure?

The adhesiolysis procedure is minimally invasive, but there are a few risks to consider. While these rarely occur, they include bleeding, infection, reformation of scar tissue, and damage to tissues. In addition, there is a slight risk for rupture of the thin membrane that surrounds the spinal cord, which is called the dura mater. If this occurs, the patient will experience severe headache, but it is rare. Temporary side effects include soreness at the insertion site, slight pain of the back, and heaviness of the legs.

Resources

 

Boswell MV, Trescot AM, Datta S, Schultz DM, et al; American Society of Interventional Pain Physicians. (2007). Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 10(1):7-111.

 

Epter RS, Helm S 2nd, Hayek SM, Benyamin RM, Smith HS, & Abdi S. (2009). Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician. 12(2):361-78.

 

Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, & Smith HS. (2009). Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician. 12(2):419-35.

 

Manchikanti L, Boswell MV, Rivera JJ, Pampati VS, Damron KS, McManus CD, Brandon DE, & Wilson SR. (2005). [ISRCTN 16558617] A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain. BMC Anesthesiol. 5:10.

 

Takeshima N, Miyakawa H, Okuda K, Hattori S, Hagiwara S, Takatani J, & Noguchi T. (2009). Evaluation of the therapeutic results of epiduroscopic adhesiolysis for failed back surgery syndrome. Br J Anaesth. 102(3):400-7.