Adhesiolysis

//Adhesiolysis
Adhesiolysis 2019-01-02T15:10:46-07:00

What Is Adhesiolysis?

If you’re suffering from neck or back pain because of scar tissue build-up, adhesiolysis could help you relieve your pain. This is what you should know about this procedure and how it helps.

Adhesiolysis is sometimes called epidural adhesiolysis or percutaneous epidural adhesiolysis. During this treatment, specific medications help dissolve adhesions, or scar tissue. The procedure was developed in the 1980s by Dr. Gabor racz, a leader in pain management. It’s a treatment that helps manage pain and scar tissue buildup along the spine. Scar tissue buildup can result in nerve root compression that causes severe pain. Additionally, chronic pain can result from these irritated or inflamed nerve roots.

During an adhesiolysis procedure, your doctor injects a combination of steroids and other medications into the affected area. This minimally invasive procedure treats pain by blocking activity of the nerves in the damaged areas and by reducing fluid accumulation and infection occurrence.

Could Adhesiolysis Help Me?

The treatment typically helps patients suffering from chronic back and neck pain caused by scar tissue. For these patients, scar tissue around the nerve roots causes non-stop pain.

Inflammation and irritation of the epidural space can be responsible for scar tissue growth. Once the inflamed tissue aggravates nearby nerve roots, intense pain is common. This pain often radiates from the low back, then down the legs of patients. Patients who are prescribed adhesiolysis have usually had previous back or neck surgeries.

You may benefit from this procedure if you suffer from:

An adhesiolysis procedure should only take place after a physician has reviewed your MRI to determine if and where scar tissue is affecting your nerves. If a patient doesn’t respond to epidural steroid injections in the region to reduce inflammation, adhesiolysis may also be performed.

Adhesiolysis for spinal stenosis

Spinal stenosis refers to a narrowing of the spinal canal that can result in spinal nerve compression. Generally, symptoms of spinal stenosis include:

  • Sensory and motor problems
  • Muscle weakness
  • Lumbar spinal pain
  • Leg pain

These symptoms may be caused by scar tissue and inflamed spinal nerves. Patients usually have an MRI prior to this procedure and again after it is completed. Following treatment with adhesiolysis, patients typically report less pain, with some patients reporting no pain at all.

Adhesiolysis for spinal surgery syndrome

Spinal surgery can lead to scar tissue development that places pressure on spinal nerves, resulting in chronic pain in the lumbar spine. Some patients may also report leg pain with this condition.

The first line of treatment for this condition is usually epidural steroid injections. Adhesiolysis, however, has been found to provide more effective and longer-lasting pain relief. This is because steroid injections may help to reduce inflammation but do not address the scar tissue.

The mixture of steroids and additional medications administered during an adhesiolysis procedure is what helps to remove the scar tissue. Therefore, while some patients suffering from spinal surgery syndrome may report some relief from an epidural steroid injection, others may not report any relief until an adhesiolysis procedure is performed.

Spinal surgery syndrome often causes leg and back pain; however, it is not always responsible for a patient’s pain. If there is scar tissue along the spine, though, it may be adding to a patient’s lumbar pain, leg pain, or even cervical pain. In these cases, adhesiolysis provides more pain relief than steroid injections alone.

Adhesiolysis | PainDoctor.com

How Is Adhesiolysis Performed?

Adhesiolysis is sometimes called the “Racz” procedure as it was founded by Dr. Gabor Racz.

To start, your doctor will give you a mild sedative and place you in a prone position. Your doctor will use an X-ray to guide them and visualize the spine. In addition, they’ll inject contrast dye to show the area where scar tissue buildup is taking place.

If nerve root inflammation is causing your pain, a needle is placed into the back in the lower posterior region, close to the buttock, and a steroid is injected via the needle to relieve the pain. Conversely, if scar tissue is responsible for your pain, X-rays can help guide a slightly bigger needle into the area.

Once the needle is in the proper position, your doctor will insert a catheter to administer the mixture of medications that decreases scar tissue, thereby reducing inflammation and pain. Occasionally, they may use a balloon to create more room around the compressed nerve before the injection.

This procedure emphasizes needle and catheter placement in the posterior of the back as opposed to directly into the spine due to the potential adverse events that are associated with incorrect placement. Another benefit of this needle and catheter placement is that it improves the distribution of medication to affected regions. Additionally, your physician performing the procedure may utilize pulsed radiofrequency to encourage nerve regeneration if it is needed.

Patients will wait at least 30 minutes for the local anesthetic to dissipate. Patients report the anti-inflammatory medications begin to relieve pain within 48 hours of the procedure.

Side effects and risks

There are rare cases when incorrect needle placement can perforate the sac that encases the spinal cord in patients that have a spine that extends lower than expected. This form of elongation of the spine can be the result of anatomic variations, disease, or physical abnormalities.

Your doctor can avoid this type of adverse event by utilizing magnetic resonance imaging (MRI) prior to the procedure to check for physical variations.

Conclusion

Adhesiolysis is a minimally invasive procedure that can help treat pain and scar tissue buildup along the spine. Your doctor performs the procedure by inserting a needle and catheter into the affected area and then injecting steroids and additional medications to dissolve scar tissue that is causing the pain.

If you’re suffering from spinal surgery syndrome, spinal stenosis, leg pain, lumbar pain, or cervical pain,  adhesiolysis could help. You may have already undergone steroid injections initially. However, adhesiolysis is often necessary for patients to report a significant improvement in symptoms.

If you think this procedure could help you, talk to your doctor. They’ll be able to provide more information about this procedure and how it could work for you. If you’re not already working with a pain specialist, you can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.

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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.

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