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 Dr. Columbus.
