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Adhesiolysis

Adhesiolysis provides therapeutic relief for patients suffering from pain due to scar tissue in their epidural space. Common conditions for which this procedure is used include lumbar disc herniations/radiculopathy, lumbar spinal stenosis, lumbar degenerative disc disease, and lumbar post-laminectomy syndrome.

The formation of adhesions or scar tissue is part of the healing process after surgery. Patients who have undergone low-back surgery may have scar tissue or adhesions in their epidural space. Similar adhesions can occur after a disc rupture. Adhesions can cause pain by entrapping nerves in the epidural space. You may experience low-back pain radiating down the legs. 

In patients with prior low-back surgery, a traditional epidural steroid injection may not be successful because adhesions prevent the spread of medications. In these patients, an epidural steroid injection can be performed by accessing the epidural space through the sacral hiatus, a small opening above your tailbone. A soft flexible catheter (Racz catheter) is advanced via the sacral hiatus further into the epidural space, facilitating the delivery of medications. Medications that decrease inflammation and dissolve adhesions are injected through this catheter.   

How It Works

Adhesiolysis injections are performed under live fluoroscopic guidance for the accuracy and safety of this injection. 

  • You will be asked to lay on your stomach. 
  • Your back and buttock area will be cleaned with an antiseptic, and a sterile drape will be placed.  
  • Your JLR Center for Pain Medicine physician will inject a local anesthetic to numb the skin overlying the area above your tailbone. 
  • Then, a needle will be guided into your epidural space with x-ray guidance. 
  • A Racz catheter (a soft flexible catheter) will be placed through that needle and advanced farther into your epidural space under x-ray guidance. 
  • Contrast dye will be injected to confirm the proper spread of medications in your epidural space. 
  • Most importantly, local anesthetics, hyaluronidase, and steroids will be injected to decrease inflammation and to break up the adhesions. 
  • Finally, the needle will be removed, and a sterile dressing will be applied.

Risks

Similar to any other procedure or medication, there are potential risks (although very low) of infection, bleeding, allergic reaction, and prolonged increases in pain. Your JLR Center for Pain Medicine physician will use x-ray guidance throughout the procedure along with sterile techniques to significantly reduce these risks as well as spinal headache and nerve damage.