Gulf Coast Pain Management
Benign Pain
   

A common cause of chronic low back pain is excessive scarring of the epidural space. The epidural space is a thin area between the inside of your vertebral column and the protective layer around the spinal cord. Epidural adhesions are most commonly observed following surgical intervention of the spine, leakage of disc material into the epidural space following annular tear, or an inflammatory response. Scar tissue may restrict movement of nerves causing inflammation, therefore, creating pain.

The purpose of epidural lysis of adhesions is to eliminate deleterious effects of scar formation, which can physically prevent direct application of drugs to nerves or other tissues to treat chronic back pain with or without radiation down an extremity. The goal of epidural lysis of adhesions is to assure delivery of high concentrations of injected drugs into the target areas. Various conditions in which epidural lysis of adhesions is indicated include pot-laminectomy syndrome, epidural adhesions, disc disruption, traumatic or pathologic vertebral body compression fracture, and resistant multilevel degenerative arthritis.
 
An epidural lysis of adhesions is a procedure that was developed to help decrease chronic low back pain due to adhesions and scar tissue formation.  The physician inserts a catheter into the epidural space in order to access the area of adhesions.  This is usually done through the caudal canal, which is located at the base of the spine, via the sacral hiatus. The sacral hiatus is a natural opening in the spine near the tailbone. Aided by real-time X-ray imaging, the catheter can be seen on the monitor and directed precisely to the affected nerve root. Once the tip of the catheter is in place, medication can be injected to relieve pain at the source and dissipate the scar tissue.

The physician will inject local anesthetic to numb up the area prior to placing the catheter through the skin. Once the local anesthetic has set in, the epidural needle will then be introduced through the skin and into the sacral hiatus. Mild sedation will also be administered to ease any anxiety, however, general anesthesia is not an option since your participation in the procedure is critical to reduce the risk of any complication. Following placement of the epidural needle, the catheter is advanced into the injection site. The movement of the catheter is continuously monitored with the C-arm (X-ray) to assure safe and effective positioning. The make-up of the epidural space is very individual; therefore, predicting the ease of catheter placement can be difficult. During the placement of the catheter, you will be asked how a certain stimulus may
feel or be asked to move your toes, etc. Contrast material (a metallic fluid that shows up on X-ray) will then be injected into the epidural space to outline the epidural space, this is called and epidurogram.  Other fluids will then be injected to relieve pain, dissipate scar tissue, and reduce inflammation. Some of these fluids may include local anesthetic, enzymes and steroid formulations. The catheter will then be removed and a band-aid will be placed over the injection site.

It is very important to remember that this procedure is only a part of your treatment. The injectants help to break up the scar tissue around the nerve root and reduce swelling. The local anesthetic agent can temporarily provide pain relief, however other pain modalities such as physical therapy and exercise are necessary to help ensure an adequate recovery and gain the most benefit of the procedure. It is also important to address factors such as stress, which can exacerbate pain.

The main risks involved in epidural lysis of adhesions include but are not limited to subarachnoid or subdural injection of fluids, worsening of pain, inability to relieve pain, paralysis, bowel or bladder dysfunction, spinal cord compression from loculation of the injected fluids or hematoma, infection, reaction to medications, and catheter shearing.

If you have any questions whatsoever regarding epidural lysis of
adhesions, please do not hesitate to ask Lynne Lynne Carr Columbus, D.O.