Name of the Procedure:

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

Summary

Percutaneous lysis of epidural adhesions is a minimally invasive procedure that aims to break up scar tissue within the epidural space of the spine. This is achieved through the injection of solutions like hypertonic saline or enzymes, or by using mechanical tools such as a catheter, often guided by imaging techniques like X-ray or fluoroscopy to ensure precision.

Purpose

This procedure is designed to relieve chronic back pain or nerve root pain caused by scar tissue (adhesions) that compress or irritate spinal nerves following surgery, injury, or inflammation. The goal is to improve spinal mobility and reduce discomfort.

Indications

• Persistent back or leg pain not relieved by conservative treatment.
• Failed back surgery syndrome (FBSS).
• Spinal stenosis or conditions leading to epidural fibrosis.
• Chronic sciatica.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Medication adjustments might be necessary, especially if the patient is on blood thinners.
• Pre-procedure imaging tests (MRI or CT scans) may be required to identify the exact location and extent of adhesions.

Procedure Description

1. Prepping and Anesthesia: The patient is positioned on the procedure table, and the skin over the spine is cleaned and numbed with a local anesthetic.
2. Radiologic Guidance: Using fluoroscopy (live X-ray), the physician identifies the exact locations of the adhesions.
3. Catheter Insertion: A small catheter is inserted into the epidural space.
4. Adhesiolysis: Solutions like hypertonic saline or enzymes are injected through the catheter to dissolve adhesions, or mechanical tools may be used to break down the scar tissue.
5. Contrast Agent: A contrast dye may be injected to visualize the spread of the solution and ensure proper distribution.
6. Multiple Sessions: If necessary, the process can include several sessions over one day.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

It is performed in a hospital or outpatient surgical center, often in a specialized pain management or radiology suite.

Personnel

• Pain management specialists or interventional radiologists.
• Radiologic technologists.
• Nursing staff.
• Anesthesiologist, if sedation is required.

Risks and Complications

• Common risks: Temporary pain at the injection site, headache, and bleeding.
• Rare but serious complications: Infection, nerve damage, allergic reaction to contrast dye or medications, and dural puncture leading to cerebrospinal fluid (CSF) leak.

Benefits

• Potential for significant reduction in pain.
• Improved spinal mobility and quality of life.
• Some patients may experience relief shortly after the procedure, while others may see gradual improvement over several weeks.

Recovery

• Patients are usually monitored for a short time post-procedure and can often go home the same day.
• Instructions may include rest, avoiding strenuous activities, and applying ice packs to manage discomfort.
• Follow-up appointments to assess effectiveness and need for additional treatment.

Alternatives

• Conservative treatments: Physical therapy, medications, and lifestyle modifications.
• Other interventional procedures: Epidural steroid injections, spinal cord stimulators.
• Surgical options: More invasive surgeries, such as spinal fusion or laminotomy, may be considered if less invasive methods fail.

Patient Experience

• During the procedure: A sensation of pressure or mild discomfort; sedation may be offered if necessary.
• After the procedure: Mild soreness at injection sites, manageable with over-the-counter pain medications. Full recovery to normal activities is expected within a few days, barring any complications.