Epidural Lysis of Adhesions
How does the lysis procedure work?
The physician will insert a special catheter (a small tube about the thickness of a pencil lead) into the region of scar tissue inside the spinal canal under fluoroscopy (X-ray guidance). The physician will advance the catheter using real-time imaging into the scarred area in order to break up scar tissue using various tissue-softening medications as well as the mechanical force of the catheter itself. The catheter maneuvering and the injections of the various medications are all performed under IV conscious sedation. The procedure will take several hours of time in the pain clinic and you will be observed in the recovery room for medication effects during part of the procedure. The movement of the catheter within the region of scar is continuously monitored with the fluoroscope to assure safe and effective catheter positioning. A MAPS physician will inject contrast material to see an outline of the scar tissue on the fluoroscope monitor. Contrast material is simply a dense fluid that shows up on X-ray and is not harmful to the human body. Other fluids and medications including enzymes, local anesthetics, steroids and hypertonic saline will also be injected through the catheter to relieve pain, dissipate scar tissue and reduce inflammation. Remember, the lysis procedure is only part of your treatment. The injections help to reduce swelling and to break up the scar tissue around the nerve roots. The anesthetic agent will temporarily provide pain relief, however, specialized physical therapy is necessary to after the procedure to help sustain improvement. Our MAPS physical therapists will provide physical therapy services once the scar tissue reduction has been completed.
What to expect
After you have been prepared by one of the MAPS nurses, an IV will be started and IV conscious sedation will be administered to reduce potential discomfort. You will be transported to the procedure room and a MAPS physician will inject a local anesthetic into the skin (usually over the tail bone area) where the catheter will be introduced. This may cause a very brief pinching sensation. After the anesthetic takes effect, a spinal needle will be inserted usually into the tail bone area (sacral hiatus). The catheter is advanced through this needle to the injection site. During the procedure you may be asked how you are feeling and if any of your usual pain is being reproduced by the movement catheter. Medications will be injected under fluoroscopy.
Once the medications have been administered, you will be moved to the recovery room where more medications will be injected into the catheter. After a period of time, you will be transported back into the procedure room where the final medications will be administered and the catheter will be removed. You will then be moved back to the recovery room for observation after which you will be discharged to home. You will not be able to drive or return to work for the rest of the day but may resume your normal activities the day after the procedure.