What is Lysis of Adhesions?
Lysis of adhesions explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Lysis of adhesions is a treatment approach that is utilized to reduce back pain that develops after surgery. In some cases, back surgery or spinal surgery may lead to the formation of scar tissue on spinal nerves. More specifically, spinal surgeries cause excessive scarring in 10-25% of the cases. Typically scar tissue begins to grow in the spaces between the targeted vertebrae and this results in the reoccurrence of the pain the surgery was meant to resolve. Moreover, the development of scar tissue leads to the compression of spinal nerves as well as inflammation and swelling. Pain that is felt in the sacroiliac joint (the tailbone) and spinal stenosis may also occur.
Accordingly, the purpose of performing a lysis of adhesions is to lyse or destroy scar tissue that is often referred to as adhesions. It has been reported that this procedure successfully provides short- and long-term relief from pain that occurs after surgery.
How is Lysis Of Adhesions Performed?
The lysis of adhesions procedure may also be referred to as the Racz treatment approach. During the procedure, the targeted area is initially numbed with local anesthesia. Imaging techniques such as magnetic resonance imaging (MRI) or fluoroscopy are generally used in order to allow the physician to visualize the affected area and the presence of scar tissue. Furthermore, a technique called endoscopy, which involves inserting a narrow camera into the back, is often utilized in conjunction with the lysis of adhesions procedure as this provides additional visualization and accuracy. When fluoroscopy is utilized, a contrast agent such as omnipaque may be initially injected to improve the visibility of the targeted area.
These types of imaging techniques help guide the placement of the needle and catheter into the scar tissue in order to facilitate the injection of medication that dissolves or breaks the scar tissue into small pieces that the body can excrete. A combination of saline and an enzyme called hyaluronidase, which degrades scar tissue, is typically injected. Furthermore, anesthetics are injected to reduce pain, in addition to steroids that decrease inflammation.
There are certain risks associated with lysis of adhesions. The needle is inserted into the area between the vertebrae called the epidural space. If the needle is improperly inserted, the medication may be administered to a region known as the subarachnoid cavity and this may lead to nerve damage. Additional complications that may occur include a loss of sensation or a spinal block, which may temporarily cause hindered movement. Furthermore, a headache that is the result of a lumbar puncture may develop after this procedure, but it generally subsides on its own. Catheter shearing may also occur and this results in skin, muscle, or nerve damage.
There is a small chance that the injected medication may also cause side effects. For instance, steroids may cause weight gain, increased blood sugar levels, arthritis, a weakened immune system, and stomach ulcers. The anesthetic that is administered could also interact with medication that the patient takes regularly or result in nerve desensitization. Some patients may even experience adverse reactions to the anesthesia such as nausea, respiratory problems, and chest pain as well as short-term neurological deficits.
Conditions Related To Lysis Of Adhesions
The lysis of adhesions procedure is generally performed in order to reduce scarring that develops after spinal surgery. Surgery on the iliosacral joint in the back often results in the formation of scar tissue on spinal nerves, which causes pain, inflammation, or irritation and necessitates lysis of the adhesions. In addition, scar tissue may result in spinal nerve compression or stenosis. These conditions cause symptoms such as the abnormal or complete loss of sensation and paralysis in some cases, but this is rare. After the lysis of adhesions is performed, patients often report a significant reduction in pain and large percentages of patients regain approximately 50% of their normal sensation and function.
It has been reported that pain relief lasts for four to 12 weeks after this form of treatment. Although lysis of adhesions is frequently recommended for low back pain, a study that evaluated the utilization of this procedure for the treatment of cervical stenosis demonstrated positive results. Cervical stenosis is characterized as neck pain that is caused by spinal nerve compression. The study reported that the application of lysis of adhesions for this condition provided over 70% of the patients with pain relief that persisted for six months.
Lysis of adhesions is typically performed to decrease the amount of scar tissue that can develop after spinal surgery. The scarring that develops causes nerves in the back to become irritated or inflamed and this results in the recurrence of pain. The procedure involves directly injecting medication, such as anesthesia and steroids, that dissolve scar tissue and decrease inflammation into the spinal region where scar tissue has developed.
The main risk that is associated with lysis of adhesions is the improper placement of the needle, but this complication can be avoided by using imaging techniques such as endoscopy or fluoroscopy while the needle is being inserted. Side effects that occur more often include sensory deficits and a headache that is the result of a lumbar puncture, but these side effects are usually short-term and not harmful.
This procedure is generally performed to treat stenosis or back pain that occurs after surgery, but it is also effective at improving the symptoms of neck pain that is associated with cervical stenosis. Overall, this treatment approach is safe and effectively relieves pain for extended lengths of time.
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