Epidural adhesions are often caused by leakage into the lumbar spine's epidural space following surgical intervention. Adhesions can bring about persistent leg pain, but pain physicians are capable of breaking up the scar tissue that forms and causes this pain with the use of a special catheter and combination of medications. This procedure is known as epidural lysis of adhesions.


 

Using x-ray guidance, the physician inserts the catheter (a small tube about as thick as pencil lead) into the region of scar tissue inside the spinal canal. The catheter is then advanced into the scarred area with real-time imaging. Various tissue-softening medications can also be administered. These steps, in addition to the mechanical force of the catheter itself, help break up scar tissue. All along, the movement of the catheter within the region of scarring is continuously monitored with the fluoroscope, in order to assure safe and effective catheter positioning.

During the procedure, the physician injects contrast material, a dense fluid that can be read by X-ray but is not harmful to the body, to see an outline of the scar tissue on the fluoroscope monitor. Other fluids and medications, including enzymes, local anesthetics, steroids and hypertonic saline are also injected through the catheter to relieve pain, destroy scar tissue and reduce inflammation. This procedure, performed under IV conscious sedation, takes several hours, including time that the patient is observed in the recovery room.

Anesthetic agents temporarily provide pain relief, but specialized physical therapy is necessary to help sustain improvement after the procedure. The MAPS physical therapy team is happy to offer their services once the scar tissue reduction has been completed.