Chronic neck and low back pain can arise from scar tissue formation in the epidural space and around nerve roots. Scar tissue can form after spine surgery or from chronic inflammation and irritation of the epidural space. Percutaneous lysis of adhesions is a procedure to “break up” the scar tissue in the epidural space.

Before the procedure, blood thinners such as heparin, warfarin (coumadin), aspirin, and anti-inflammatory medications (except for celebrex) must be discontinued 5 days prior to the procedure date. If you are being treated by any specialist, medical clearance may be needed to proceed. The morning of the procedure, you may have something to eat or drink but nothing within 2 hours of the procedure.

At the surgical center an IV will be started by a nurse. When ready you will be taken to the surgical suite where you will be placed on your stomach. This sterile procedure is performed under IV sedation. The area above your buttock will be prepped and anesthetized with lidocaine (local anesthetic). Then under fluoroscopic (real time x-ray) guidance, a catheter guide wire is placed into the epidural space. Once the catheter is in the proper location where the scar tissue is affecting the nerve root, saline, steroid and contrast is injected and the catheter manipulated to dissolve the scar tissue and reduce the inflammation and irritation on the nerve. During the procedure your vital signs and oxygen saturation will be continuously monitored. After the injection, you will be taken to the recovery area and be evaluated. You will be monitored until discharge criteria are met.

You will need a family member or friend drive you home following the procedure. No exceptions. You may experience some temporary spasms near the injection site. If this occurs use ice or heat, whichever works best for you. If you are using ice, place a thin clothe barrier between your skin and the ice pack. Apply for 20 minutes to the affected area and you may reapply in 60 minutes if needed. If you are applying heat (moist or dry heat) refer to the manufacturer‘s instructions for application. Never sleep on a heating pad, burns may occur.

Complications are rare and include but not limited to bleeding, infection, damage to nerves and structures of the spine, spinal headaches, perforation of organs, collapsed lung, reaction to medications, increased pain, seizure, stroke, paralysis, damage to fetus if pregnant and death. You may be given antibiotics during the procedure. Your usual pain may be increased for a few days after the procedure. The risk of injection of steroids include thinning of bones, pathologic fractures, weakening of ligaments, damage to tissues, avascular necrosis of the hip, cataracts, decreased immunity, reaction to medication. Complications are rare. Side effects that occur commonly include flushing, fluid retention, rash, weight gain, insomnia, headache. Diabetics will have significant increased in blood sugars for a few days and will need to monitor their blood sugar levels closely and adjust medication as directed by their family physician. Sedation is used for patient comfort and to facilitate performance of the procedure. Complications of sedation are very rare and include aspiration, pneumonia, and loss of airway requiring emergency resuscitation or surgery. The risk of complications requiring transfusion is extremely low. The risks of transfusion of blood products include transfusion reaction, infection such as HIV or hepatitis and death.

© Copyright 2009 All Rights Reserved