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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.
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