What is Adhesiolysis?
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Adhesiolysis is a minimally invasive form of treatment for pain and the accumulation of scar tissue along the spinal column. Excessive scar tissue can lead to the compression of nerve roots and intense pain. Inflamed and irritated nerve roots can also cause chronic pain. When an examination shows that inflamed nerve roots are responsible for pain that is being experienced, a needle is carefully inserted into the lower posterior region of the back near the buttocks, directly below the spine. Steroids are then injected through the needle in order to treat the pain.
When it is determined that scar tissue is causing the pain, x-ray imaging is used to carefully insert a larger needle into the posterior region of the back. After the needle has been correctly placed, a catheter is inserted through the needle in order to administer steroids and additional medications that dissolve scar tissue and subsequently reduce pain and inflammation. This procedure also effectively treats pain by blocking nerve activity in damaged regions and reducing fluid accumulations called edemas as well as the occurrence of infections.
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How is Adhesiolysis Performed?
Adhesiolysis is also referred to as epidural adhesiolysis or percutaneous epidural adhesiolysis. This procedure focuses on placing the needle and catheter near the posterior as opposed to placing it into the spine, due to the increased risks that are associated with improper placement. In addition, when the needle and catheter are placed into the spine, injected medication often spreads quickly to the buttocks while only minimal amounts reach the damaged regions of connective tissue along the spinal column. Posterior placement, on the other hand, improves the administration of medication to the affected areas.
In a small number of cases, improper needle placement has caused the puncturing of the sac that encloses the spinal cord in patients whose spine extends to lower than expected regions. Disease, anatomical variations in body structure, and physical abnormalities are thought to cause this type of spinal elongation. However, this type of risk can be avoided by checking for physical abnormalities through magnetic resonance imaging (MRI) prior to conducting this procedure. Generally, MRIs are requested before this procedure is considered in order to identify possible causes of pain and discomfort that may be related to the spinal column.
Conditions Related To Adhesiolysis
Conditions that are treated with adhesiolysis include:
- Spinal stenosis
- Post lumbar surgery syndrome (spinal surgery syndrome)
- Back and neck pain
- Leg pain
Spinal stenosis is the narrowing and subsequent compression of spinal nerves. This condition causes symptoms such as motor and sensory problems, muscle weakness, low back pain, and leg pain, which may be the result of inflamed spinal nerves and scar tissue. Percutaneous epidural adhesiolysis is commonly used to treat spinal stenosis and involves the injection of steroids and medication into the spinal region through a posteriorly placed needle and catheter. Patients with spinal stenosis generally undergo an MRI before this procedure is conducted and after treatment, patients usually report experiencing moderately less pain, very little pain, or no pain at all.
Post lumbar surgery (spinal surgery) may cause low back pain and even leg pain in some patients. When this occurs, epidural steroid injections are often utilized as the initial form of treatment, but percutaneous epidural adhesiolysis has been shown to be more effective long-term. Spinal surgery can lead to the development of scar tissue that places pressure on spinal nerves, which can in turn cause chronic pain.
Steroid injections alone may improve inflamed spinal nerves, but not the presence of scar tissue. It is the combination of medication and steroids that are administered through the needle and catheter during percutaneous epidural adhesiolysis that causes pain-inducing scar tissue to dissolve. Subsequently, patients with post lumbar surgery syndrome may not experience a significant improvement of symptoms until they undergo the percutaneous epidural adhesiolysis procedure.
Although post lumbar surgery syndrome may often cause back pain and leg pain, it may not always be the cause of these conditions. However, if it is discovered that scar tissue along the spine may be contributing to pain in the back, legs, or even the neck, percutaneous epidural adhesiolysis is still more effective than treating these conditions with steroid injections alone.
Adhesiolysis is a form of treatment for pain and scar tissue along the spinal column that is minimally invasive due to the use of a needle that is placed in the lower posterior of the back. When inflamed nerve roots along the spine are responsible for pain, the needle is used to inject steroids that reduce inflammation. If scar tissue is causing nerve root compression and pain, a larger needle and a catheter are used in order to inject steroids and different types of medication that dissolve the scar tissue along the spinal column.
The procedure may be referred to as epidural adhesiolysis or percutaneous epidural adhesiolysis, but the main focus involves placing the needle in the posterior region near the buttocks that is directly below the spine to reduce the risk of puncturing the spinal encasing or spinal nerves. This type of placement also helps ensure that the medication will be properly administered to the affected areas.
Adhesiolysis has been used successfully to treat conditions such as spinal stenosis, back pain, neck pain, leg pain, and post lumbar surgery syndrome, also known as spinal surgery syndrome. The epidural or posterior injection of steroids is often utilized first to treat pain that is caused by these conditions, but dramatic improvement is normally reported until after adhesiolysis is performed. In such cases, it is usually necessary to administer medication that dissolves scar tissue in addition to reducing the inflammation of spinal nerves. Currently, MRIs are utilized to identify whether inflamed nerves, scar tissue, or a combination of both are causing pain before deciding if this procedure should be performed.
- Choi E, Nahm FS, Lee PB. Evaluation of prognostic predictors of percutaneous adhesiolysis using a Racz catheter for post lumbar surgery syndrome or spinal stenosis. Pain Physician. 2013;16(5):E531-536.
- Kim SG, Yang JY, Kim do W, Lee YJ. Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation. Korean J Pain. 2013;26(2):203-206.
- Manchikanti L, Cash KA, McManus CD, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. Int J Med Sci. 2013;10(1):50-59.
- Manchikanti L, Singh V, Cash KA, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial. J Pain Res. 2012;5:597-608.
- Park CH, Lee SH. Effectiveness of percutaneous transforaminal adhesiolysis in patients with lumbar neuroforaminal spinal stenosis. Pain Physician. 2013;16(1):E37-43.