FAQs on Lysis of Adhesions

Epidural adhesions are caused by leakage of the disc’s inner material into the space around the spinal cord (epidural space). Adhesions cause persistent leg pain, leg numbness, and leg weakness. Lysis of adhesions is a procedure to remove these areas of scar tissue.

How do I prepare for this procedure?

Before having the epidural, you should notify the doctor of all medications you are taking. In addition, you should arrange to have someone drive you home. When you come to the surgical facility, a nurse goes over the procedure pros and cons, has you sign a form of informed consent, and asks you to change into a procedure gown. The nurse will put an IV catheter in your hand to administer sedatives, medications, and fluids, if they are necessary.

How are adhesions removed?

The nurse will position you face-down on a special procedure table, clean your back with an antiseptic, and numb the skin and deeper tissues using an local anesthetic. Using diagnostic imaging to assure correct placement of the needle catheter, the doctor guides the needle into the epidural space. Tissue-softening solutions are administered, and the force of the catheter breaks up the adhesion tissue. The doctor injects contrast dye into the epidural area to visualize the scar tissue.

What medications are used in the lysis procedure?

Enzymes, steroids, and hypertonic saline can be injected to destroy scar tissue, reduce inflammation, and relieve pain. Before the procedure, Versed or lorazepam is given as a sedative. Lidocaine or bupivacaine are used to anesthetize the skin and relieve pain in the epidural space.

How long does the procedure take?

The total procedure time varies, depending on the extent of damage and scar tissue buildup. Average time of the procedure is between 30 and 60 minutes.

Who needs the lysis of epidural adhesions procedure?

This procedure is used as an interventional pain relief effort. Patients who have had epidural steroid injections, those with a history of back surgery, people with herniated discs, and individual with spinal stenosis all would benefit from lysis of adhesions.

How common is failed back surgery syndrome (FBSS)?

After back surgery, not every patient makes a full recovery. When pain and other symptoms continue, it is called failed back surgery syndrome. The prevalence rate of FBSS is around 15-25%, but this varies depending on the study. After spinal surgeries, 25% of patients develop scar tissue, which forms near the spinal cord.

What can I expect after the lysis of adhesions procedure?

After the adhesion removal procedure, you will be monitored by a nurse for around 20-30 minutes. Expect to have some soreness at the needle insertion site, but this will resolve within a few hours. Many patients report tingling, swelling, and soreness down the legs. When you go home, rest for 1-2 days, and gradually return to usual activities as tolerated.

Why remove adhesions?

Scar tissue, and foreign material in the epidural region, can cause a threat to normal motor or sensory functions. This scar tissue also affects the surrounding spinal structures, such as the nerves and the spinal cord. Eventually, this tissue compresses (impinges) upon the sensory structures.

Is the epidural adhesiolysis procedure successful?

In a 2009 study, researchers found that 90% of patients reported at least 50% of improvement in symptoms. These effects lasted for up to 12 months, with 73% of patients reporting pain relief after one year post-procedure.

Resources

Lee F, Jamison DE, Hurley RW, & Cohen SP (2014). Epidural Lysis of Adhesions. Korean Journal of Pain, 27(1), 3-15.

Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. Pain Physician. 2009;12:E355–E368.