FAQs on Adhesiolysis

Adhesiolysis is a simple medical procedure performed to stop spine pain and associated symptoms. With spinal damage comes nerve compression, and nerve compression causes radiculopathy (radiating pain to buttocks, legs, and feet, usually on one side). Also called epidural lysis of adhesions, this procedure involves dissolving scar tissue (adhesions) that form in the epidural space near nerve roots.

Why remove epidural adhesions?

Epidural adhesions occur from surgical procedures, such as back surgery. They also occur when disc material leaks from the inner disc (nucleus) through the tough, fibrous outer disc layer (annulus). These adhesions cause pressure (compression) of one or more nerve roots, which cause radiculopathy.

Why perform an adhesiolysis procedure?

Epidural adhesions do not only cause pain, but they interfere with certain therapeutic procedures, such as epidural steroid injections (ESIs). The purpose of removing scar tissue is so medications can easily flow through the space around the spinal cord (epidural space).

Does adhesiolysis work?

In one review of several randomized controlled studies, adhesiolysis was proven as an effective therapy for treating chronic refractory back pain with associated radiculopathy. The efficacy rate of this procedure is around 76-80%, and many study participants reported more than 50% reduction in chronic pain.

How do I prepare for the adhesiolysis procedure?

Because you will be given sedatives, arrange to have someone drive you home. Expect to be home from work or school for a few days after the procedure. When you arrive at the facility, a nurse will discuss the pros and cons of the adhesiolysis procedure and have you sign a form of informed consent. After changing into a gown, the nurse places an IV catheter in your arm to administer medications and fluids.

What can I expect during the adhesolysis procedure?

After being positioned on the procedure table, a nurse will administer a mild sedative. The doctor numbs the skin and deeper tissues of the lower back with an anesthetic. Once numbed, the doctor inserts a hollow needle with catheter into the epidural space. Diagnostic imaging is used for correct needle placement. To dissolve adhesions, certain medications are injected through the catheter. This reduces inflammation and relieves tissue irritation. Once the process is complete, the catheter is removed and a soft, dry bandage is applied. Medications used include hypertonic saline, omnipaque, hyaluronidase, anesthetics, corticosteroids, or a combination of any of these substances.

What happens after the procedure?

The procedure takes between 30-60 minutes from start to finish. Afterwards, a nurse will monitor you for approximately 30 minutes to assure you are recovering normally. The doctor asks you questions concerning your pain, and discharges you with home instructions. You are asked to not return to usual activities for several days, and should take it easy the rest of the day.

What are the benefits of adhesiolysis?

This procedure is used to safely remove scar tissue and helps with pain relief. Ahesiolysis is also beneficial, and has a success rate of approximately 95%. For many patients, the results last for several years.

What complications, risks, and side effect are associated with this procedure?

The adhesiolysis procedure is cost-effective and safe. While rare, side effects include infection, bleeding, formation of scar tissue, tissue damage, and rupture of the membrane around the spinal cord, which is called the dura mater. Temporary side effects affect most people, and include slight pain of the back, soreness at the needle insertion site, and heaviness of the legs.

Resources

Epter RS, Helm S 2nd, Hayek SM, Benyamin RM, Smith HS, & Abdi S. (2009). Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician. 12(2):361-78.

Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, & Smith HS. (2009). Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician. 12(2):419-35.

Manchikanti L, Boswell MV, Rivera JJ, Pampati VS, Damron KS, McManus CD, Brandon DE, & Wilson SR. (2005). [ISRCTN 16558617] A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain. BMC Anesthesiol. 5:10.

Takeshima N, Miyakawa H, Okuda K, Hattori S, Hagiwara S, Takatani J, & Noguchi T. (2009). Evaluation of the therapeutic results of epiduroscopic adhesiolysis for failed back surgery syndrome. Br J Anaesth. 102(3):400-7.