What is Adhesiolysis?

Adhesiolysis explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Spinal Column - AdhesiolysisAdhesiolysis is a minimally intrusive pain treatment that is typically performed when scar tissue begins to accumulate on the spinal column. Excessive scar tissue places nerve roots under excessive amounts of pressure, which leads to intense pain. In addition, irritated and inflamed nerve roots can lead to chronic pain. Inflamed nerve roots may be treated by carefully inserting a needle into the lower back just below the spine and injecting steroids in order to reduce pain and inflammation.

If a large amount of scar tissue is causing back pain, a larger needle is inserted into the back , guided by X-ray imaging. Correct needle placement is confirmed and then 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.

How is Adhesiolysis Performed?

Neck PainAdhesiolysis is also called percutaneous epidural adhesiolysis or epidural adhesiolysis, and the procedure focuses on placing the needle into the lower back (referred to as the posterior) and then inserting a catheter through the needle. This method reduces the risks that are associated with placing a needle directly into the spinal column and decreases the occurrence of improper placement. Inserting a needle and catheter into the spine instead of in the lower back near the spine, causes injected medication to rapidly spread to the buttocks and this prevents the majority of the medication from reaching damaged spinal tissue. Therefore, posterior placement improves the delivery of steroids to the affected regions.

If an individual has physical abnormalities due to anatomical variations of the spine or a disease that has caused spinal elongation, improper placement of the needle may lead to a puncture in the sac that encases the spinal cord. Physicians can avoid these types of risks by using imaging techniques such as magnetic resonance imaging (MRI) in order to evaluate the structure of the spine. MRIs are generally performed before recommending adhesiolysis to help identify the possible cause of discomfort and pain in the spinal region.

Conditions Related To Adhesiolysis

The following conditions can be treated with adhesiolysis:

  • Post lumbar surgery syndrome, also known as spinal surgery syndrome
  • Back and neck pain
  • Spinal stenosis
  • Leg pain

AdhesiolysisSpinal stenosis is a condition in which the narrowing of the spinal cord causes nerves to become compressed. Symptoms associated with spinal stenosis include muscle weakness, low back pain, leg pain, and sensory or motor deficits, all of which may be due to scar tissue and inflamed spinal nerves. Percutaneous epidural adhesiolysis is the preferred treatment method for spinal stenosis and entails injecting medication and steroids near the spinal region through the posterior placement of a needle and catheter. Spinal stenosis patients who undergo adhesiolysis generally report a moderate, significant, or complete loss of pain.

In some individuals, post lumbar surgery, which is also known as spinal surgery, causes both low back pain and leg pain. Scar tissue may develop after surgery and lead to chronic pain by causing spinal nerves to become compressed. If this type of pain develops after surgery, epidural steroid injections may be administered first to treat the pain, but percutaneous epidural adhesiolysis has a longer lasting effect than steroid injections. This is because steroid injections treat inflamed nerves, but do not have a direct effect on scar tissue, while the medication and steroids that are injected during percutaneous epidural adhesiolysis have the ability to dissolve scar tissue. Therefore, some patients who begin to feel pain after spinal surgery may not experience significant relief until they undergo adhesiolysis.

Conclusion

Adhesiolysis is a pain treatment that has the ability to reduce scar tissue along the spinal cord. It is minimally invasive and entails the placement of a needle in the lower posterior of the back. If inflamed nerve roots are causing pain in the spinal region, steroids are injected through the needle to reduce inflammation. If pain and nerve root compression are the result of scar tissue, steroids and several medications that dissolve scar tissue are injected through a needle and catheter.

Adhesiolysis is used to successfully treat conditions such as post lumbar surgery syndrome, back pain, leg pain, neck pain, and spinal stenosis. Currently, imaging techniques (e.g. MRI) are used to determine if scar tissue, inflamed nerves, or both factors are responsible for the pain before recommending this procedure.

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References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Park CH, Lee SH. Effectiveness of percutaneous transforaminal adhesiolysis in patients with lumbar neuroforaminal spinal stenosis. Pain Physician. 2013;16(1):E37-43.