frequent procedures
 

EPIDURAL LYSIS OF ADHESIONS (ADHESIOLYSIS)
Frequently, scar tissue formation within the epidural space at any level, including cervicothoracic or lumbar, can become chronic sources of pain generation in patients with chronic pain. Most frequently, scarring in the epidural space is seen status post multiple surgeries in the axial spine region, and may be located in the thoracic, cervical, or lumbar region. Most scar tissue in the lumbar spine area do not result in strangulation of painful binding to nerve roots resulting in low back pain. However, a small sub-group of these patients with scar tissue will experience significant destruction and alteration of the anatomy and physiology of the area involved, and result in axial spine area pain as well as radicular pain to upper or lower extremity, or the chest wall or abdomen, as the case may be. The incidence and frequency of occurrence of scar tissue-mediated pain in the epidural space increases with the number of surgical interventions in the same region in any particular patient.

Adhesiolysis or epidural lysis of adhesion, involve an attempt to disburse or disintegrate already formed scar tissue in order to ultimately relieve pain in these patients. In some clinical situations, the scar tissue may be encasing the nerve roots that lie outside the thecal sac and results in radicular pain to the lower extremity as well as low back pain or thoracic axial pain and intercostal neuritis, or sub _____pain and upper extremity radicular symptoms. A careful assessment with an epidurogram as well as a negative MRI study and evidence of non-mechanical instability as in flexion and extension of the lumbar or cervical spine may begin to serve as a pointer that origin of pain in the axial spine in the extremities or thoracic or abdominal wall may be coming from the scar tissue in the area concerned. The epidural lysis of adhesions consists of an attempt to break down the scar tissue using a spring-loaded and guided caliper such as the Racz caliper, which is advanced to the appropriate level under fluoroscopic guidance and used to mechanically lyse the adhesion as close to the neuroforaminal exit as well as the central portion of the spinal canal as possible. Very often, this may not be a one-step procedure, and may required staged repeated procedures to achieve full lysis in cases where the scar tissue has formed thick, solid encasements. Lysis of adhesions are often also complimented with enzyme injection, using syaluronidase enzymes in addition to local anesthetic _____, 10 percent hypertonic saline. Ten percent hypertonic saline can be a useful tool in reducing inflammation or swelling following this aggressive mechanical lysis of adhesion within the spinal canal compartment. It can also, to some degree, serve to dissolve scar tissue.

Lysis of adhesion is frequently done as mechanical lysis of adhesion with hypertonic saline, (10 percent sodium chloride), or chemical lysis of adhesion with enzyme used in the spring-loaded caliper, which is advanced under fluoroscopic guidance to the various levels targeted, or a combination of both. This procedure can be extremely effective, if elected, or patients may require a repeat procedure over time to achieve the desired objective of pain reduction and improve quality of life.

CONTRAINDICATIONS:
1. Patients who are pregnant or suspect that they may be pregnant should avoid all x-ray-guided procedures, including this procedure.
2. Patients on Coumadin, Heparin, or other blood thinner, or even patients on aspirin should seek advice concerning how long they should discontinue these anticoagulants before this procedure is done. Coumadin is usually discontinued for three days before the procedure is done, and aspirin is usually discontinued as an anti-platelet agent, for five to seven days prior to the procedure being done.

COMPLICATIONS: The complications are very uncommon in this procedure. However, possible complications include transient and temporary partial bladder incontinence, infection, or allergy to contrast material.

SEDATIVES: Sedatives are not usually needed, however, anxious patients or patients on request may get sedatives prior to this procedure being done. The procedure is usually quick, and effective.
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