Name of the Procedure:

Percutaneous Lysis of Epidural Adhesions using Solution Injection or Mechanical Means with Radiologic Localization (Adhesiolysis)

Summary

Percutaneous lysis of epidural adhesions is a minimally invasive procedure where solutions like hypertonic saline or enzymes, or mechanical devices like a catheter, are used to break down scar tissue in the epidural space of the spine under X-ray guidance to relieve chronic pain.

Purpose

Percutaneous lysis of epidural adhesions addresses chronic back and leg pain caused by scar tissue from previous surgeries or conditions like herniated discs. The goal is to alleviate pain and improve mobility by breaking down the adhesions and restoring function.

Indications

• Chronic back or leg pain
• Pain unresponsive to conservative treatments (e.g., physical therapy, medications)
• Previous spinal surgeries
• Conditions such as failed back surgery syndrome

Preparation

• Fast for 6-8 hours before the procedure.
• Adjust medications as instructed by the healthcare provider.
• Undergo pre-procedure blood tests and imaging, like an MRI or CT scan, for accurate localization.

Procedure Description

1. The patient is positioned comfortably, often lying face down.
2. Local anesthesia is applied to numb the procedure site.
3. A needle is inserted under fluoroscopic (X-ray) guidance into the epidural space.
4. Contrast dye is injected to visualize adhesions.
5. A catheter is used to deliver a solution like hypertonic saline or an enzyme to dissolve the scar tissue or mechanically break it down.
6. The procedure may require multiple sessions over two or more days to be effective.

Duration

Each session typically lasts 30 to 60 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center equipped with fluoroscopic imaging technology.

Personnel

• Pain management specialist or interventional radiologist
• Nursing staff
• Radiologic technologist
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Spinal headache
• Allergic reaction to contrast dye
• Temporary increase in pain

Benefits

• Pain relief
• Improved mobility and quality of life
• Minimally invasive with a relatively quick recovery time
• Alternative to more invasive surgical options

Recovery

• Post-procedure observation for a few hours
• Keep the injection site clean and dry
• Avoid strenuous activities for a few days
• Follow-up appointments to monitor progress and schedule additional sessions if needed
• Pain relief may be immediate or gradual over days to weeks

Alternatives

• Physical therapy
• Medications (pain relievers, anti-inflammatories)
• Spinal cord stimulation
• Surgical removal of adhesions
• Each alternative varies in invasiveness, risk, and effectiveness compared to percutaneous lysis.

Patient Experience

Patients may feel a pressure or mild discomfort during the procedure but should not experience significant pain due to local anesthesia or sedation. Slow improvement in pain and mobility is expected post-procedure, with continued monitoring for any complications. Pain management and comfort measures like cold packs or prescribed medications can help manage any post-procedure discomfort.