Lysis Of Epidural Adhesions
Lysis of epidural adhesions is a treatment option for patients suffering from chronic low back pain and radicular pain (pain that shoots down the thigh, calf, and sometimes into the foot). Adhesions may form after back surgery or from leakage of disc material into the epidural space. Oftentimes, the adhesions and disc material surround a nerve root, causing inflammation and severe pain.
The word “lysis” means to destroy or break up material. Using a spring-wound or steerable catheter, the doctor is able to break up the adhesions, flush out disc material, and direct medication onto the inflamed area and nerve root. Lysis of epidural adhesions is indicated after conservative treatments such as medication and epidural steroid injections have failed to relieve your pain.
Lysis of epidural adhesions is an outpatient procedure that is performed in the Operating Room under strict sterile condition. When brought to the Operating Room, you will be connected to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device). The doctor or nurse will start an intravenous line and give some medicine to help you relax. You may also receive an antibiotic. The procedure is performed with you lying on your stomach. The doctor will cleanse your lower back with antiseptic solution and inject some numbing medicine at the base of your spine. You may feel a burning sensation for a few seconds. After the area is numb, the doctor will make a small incision and insert a dilator tube through which the catheter will pass. Although you will not feel any pain, you will feel a sense of pressure.
The doctor will manipulate the catheter to the area suspected of causing your pain, and, with the assistance of a special X-ray machine called a fluoroscope, periodically inject a radiopaque dye (contrast solution) into the epidural space. During the procedure, the doctor will try to reproduce your pain and will ask you if this causes your usual pain or if it causes a different pain. Once the suspected pain- producing area is located, the doctor will break up the adhesions and inject a small mixture of numbing medicine (anesthetic), normal saline, and anti- inflammatory medicine (cortisone/steroid). After the procedure, your skin will be cleansed and a bandage applied. We ask that you remain at the Clinic until the doctor feels you are ready to leave.
Will you be asleep for the procedure? Since you need to talk to the doctor and tell him the type of pain you are experiencing, you will not be put to sleep. However, you will receive enough medication to keep you comfortable. How long will the procedure take? Normally, lysis of epidural adhesions takes from 30 minutes to an hour.
Before the Procedure
Do not eat or drink anything after midnight the day before the procedure. If you are on medications, you may take them with sips of water. If you are a diabetic, discuss your medication with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications.
It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.
After the Procedure
You may experience some weakness and/or numbness in your legs a few hours after the procedure. If so, do not engage in any activities that require lifting, balance and coordination. You may experience an increase in your usual pain including muscle soreness in your back where the catheter was inserted. Use ice packs three or four times a day and take your usual pain medications. Do not apply heat or soak in water (i.e. tub, pool, jacuzzi, etc.) for the remainder of the day. Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys.
Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending on how you feel, you may resume normal activities and return to work in one to three days. If the doctor prescribes physical therapy, it is very important that you continue with the physical therapy program. Although you may feel much better immediately after the injection (due to the numbing medicine), there is a possibility your pain may return within a few hours. It may take a few days for the steroid medication to start working.
Although very few complications have been reported, the risks involve spinal puncture resulting in a headache, infection at the injection site, infection in the spinal canal, bleeding inside the epidural space, nerve damage, and visual disturbances. If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, you should call the doctor right away.