Adhesiolysis, also called lysis of adhesions, is a treatment used to break up and eliminate scar tissue along the spine. If left untreated, this scar tissue can cause pain and inflammation. This treatment is considered minimally-invasive and can be used to help treat chronic pain and inflammation that is a result of not only scar tissue build-up but also nerve root damage that can result.
What is adhesiolysis?
Adhesiolysis is the name of the procedure developed by Dr. Gabor Racz. Also known as the “Racz” procedure or lysis of adhesions, it uses medication guided by a catheter to break up scar tissue along the spine. This scar tissue (the adhesions) can cause fluid accumulation that leads to infection or pain and inflammation as it presses on the nerves.
What conditions does adhesiolysis treat?
Adhesiolysis can be used to treat a number of chronic pain conditions, including:
Each of these conditions can result in compression of the spinal nerves. Spinal stenosis, the narrowing of the spinal column, can be particularly painful and damaging. The pain from spinal stenosis can radiate across the lower back and all the way down the leg, eventually causing permanent nerve damage.
While epidural injections may help with pain and inflammation of spinal stenosis and spinal surgery syndrome, these conditions may not be fully resolved until scar tissue build-up is removed, thereby creating more space in the spinal column and taking the pressure off the affected nerves.
The aftermath of spinal surgery may cause pain, but it is the buildup of scar tissue that may cause pain to persist and become chronic well after surgery is over. Lysis of adhesions can help remove the scar tissue that is causing pain beyond what is normal after surgery.
How is adhesiolysis performed?
Adhesiolysis is an outpatient procedure that begins with the patient resting on their stomach. The area to be operated on will be cleaned, and patients will usually be lightly sedated.
The doctor will inject a contrast dye into the area and fluoroscopy – live X-ray – will be used to ensure proper placement of the catheter. A catheter will be guided into the space where adhesions are located. To reduce pain and inflammation, a steroid may be administered.
After the steroid is administered, doctors will inject a combination of medications that might include saline and hyaluronidase. If there is very little space, the doctor may also insert and inflate a small balloon to increase space for the nerves. The doctor may also use pulsed radiofrequency to encourage the nerves to heal and regrow after the procedure.
From start to finish, the procedure takes approximately one to two hours. After the procedure, patients will rest until the anesthesia wears off and they feel stable. The effects of adhesiolysis may last up to 12 weeks after treatment. Patients will need a ride home and should rest for the day of the surgery, gradually returning to normal activity as their doctor allows.
What are the risk factors and side effects of adhesiolysis?
As with all procedures, there are risks and potential side effects. Some of these include:
- Infection: Whenever the skin is opened, the chance for infection exists. This is prevented by proper care and cleaning of the skin and incision before, during, and after the procedure.
- Reaction to medications: Patients may experience side effects from the steroids injected into the area around the adhesions.
- Headache: Whenever the area surrounding the spinal cord is operated on, the risk of temporary headache exists. The headache may be severe but should recede within a day and be able to be managed with analgesics.
- Surgical discomfort: Bruising or tenderness at the site of the incision is normal and can be managed with ice.
- Dural puncture: More severe side effects due to improper placement of the catheter may include puncture of the dural sac, the area that surrounds the spinal cord. This can result in serious side effects including loss of motor control or loss of bowel or bladder control.
Any of the following post-operative side effects are potentially serious and should be reported immediately to your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Pain that you cannot control with the medications you have been given
Does adhesiolysis work?
Multiple reviews over the years have shown that adhesiolysis gets good results for failed back surgery syndrome and spinal stenosis that is unresponsive to other treatments. A systematic review of studies in 2007 found that adhesiolysis was effective in providing significant pain relief (50% or greater) while offering functional improvement, improvement of psychological status, and an earlier return to work than other treatments (e.g., steroid injections alone).
Another review of studies by Pain Physician in 2012 reinforced earlier research findings. The 2012 study looked at 15 studies before selecting five randomized, controlled-trial studies and two observational studies to review. Together, these seven studies confirmed that adhesiolysis is effective for refractory back pain due to surgery as well as spinal stenosis. The reviewers did point out a lack of rigorous, scientifically valid literature to analyze and called for more randomized, controlled-trial studies.
Adhesiolysis does have some risk, but the potential for longer-lasting relief of pain may outweigh the risk. Talk to your doctor today to see if this procedure may work for your chronic pain.