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Gulf Coast Pain Management
Benign Pain


 
 

Epidural lysis of adhesions

 
A common cause of chronic low back pain is excessive scarring of the epidural space. The epidural space is a thin
area between the inside of your vertebral column and the protective layer around the spinal cord. Epidural adhesions
are most commonly observed following surgical intervention of the spine, leakage of disc material into the epidural
space following annular tear, or an inflammatory response. Scar tissue may restrict movement of nerves causing
inflammation, therefore, creating pain.

The purpose of epidural lysis of adhesions is to eliminate deleterious effects of scar formation, which can
physically prevent direct application of drugs to nerves or other tissues to treat chronic back pain with or
without radiation down an extremity. The goal of epidural lysis of adhesions is to assure delivery of high
concentrations of injected drugs into the target areas. Various conditions in which epidural lysis of adhesions
is indicated include pot-laminectomy syndrome, epidural adhesions, disc disruption, traumatic or
pathologic vertebral body compression fracture, and resistant multilevel degenerative arthritis.
 
An epidural lysis of adhesions is a procedure that was developed to help decrease chronic low back pain due
to adhesions and scar tissue formation.  The physician inserts a catheter into the epidural space in order to
access the area of adhesions.  This is usually done through the caudal canal, which is located at the base of
the spine, via the sacral hiatus. The sacral hiatus is a natural opening in the spine near the tailbone. Aided by
real-time X-ray imaging, the catheter can be seen on the monitor and directed precisely to the affected nerve
root. Once the tip of the catheter is in place, medication can be injected to relieve pain at the source and
dissipate the scar tissue.
 
The physician will inject local anesthetic to numb up the area prior to placing the catheter through the skin. 
Once the local anesthetic has set in, the epidural needle will then be introduced through the skin and into the
sacral hiatus. Mild sedation will also be administered to ease any anxiety, however, general anesthesia is not
an option since your participation in the procedure is critical to reduce the risk of any complication. Following
placement of the epidural needle, the catheter is advanced into the injection site. The movement of the
catheter is continuously monitored with the C-arm (X-ray) to assure safe and effective positioning. The make-up of the epidural space is very individual; therefore, predicting the ease of catheter placement can be
difficult. During the placement of the catheter, you will be asked how a certain stimulus may feel or be asked
to move your toes, etc. Contrast material (a metallic fluid that shows up on X-ray) will then be injected into
the epidural space to outline the epidural space, this is called and epidurogram.  Other fluids will then be
injected to relieve pain, dissipate scar tissue, and reduce inflammation. Some of these fluids may include local
anesthetic, enzymes and steroid formulations. The catheter will then be removed and a band-aid will be
placed over the injection site.
 
It is very important to remember that this procedure is only a part of your treatment. The injectants help to
break up the scar tissue around the nerve root and reduce swelling. The local anesthetic agent can temporarily
provide pain relief, however other pain modalities such as physical therapy and exercise are necessary to help
ensure an adequate recovery and gain the most benefit of the procedure. It is also important to
address factors such as stress, which can exacerbate pain.
 
The main risks involved in epidural lysis of adhesions include but are not limited to subarachnoid or subdural
injection of fluids, worsening of pain, inability to relieve pain, paralysis, bowel or bladder dysfunction, spinal
cord compression from loculation of the injected fluids or hematoma, infection, reaction to medications, and
catheter shearing.

If you have any questions whatsoever regarding epidural lysis of
adhesions, please do not hesitate to ask Lynne Lynne Carr Columbus, D.O.

 

 

 

©2000 - 2010 Gulf Coast Pain Management
Lynne Carr Columbus, D.O.
3890 Tampa Road Suite 308
Morton Plant Mease East Lake Outpatient Center
Palm Harbor, Florida
34684

Phone: (727) 789-0891  Fax: (727) 789-1570
E-mail:
info@gulfcoastpain.com