This injection, generally performed as an outpatient procedure under local anesthesia, relieves low back and leg pain most often caused by scarring from a prior back surgery. The procedure is performed with the patient lying face down with a cushion placed under the stomach.

Lysis of Epidural Adhesions

Different types of nerve blocks are used for different purposes.

Epidural adhesions are most commonly caused by hemorrhage into the epidural space following surgical interventions in the lumbar spine and the healing that subsequently occurs. Leakage of this material into the epidural spacer may cause an inflammatory response and result in the formation of epidural adhesions. Sometimes, these adhesions can lead to persistent leg pain following surgical procedures on the spine. With the use of a special catheter and a combination of medications, your doctor will try to break up some of the scar tissue with the goal of lessening your leg pain.

In general, this is an outpatient procedure. Once positioned properly, a fluoroscope (X-ray guidance machine) assists in identifying the sacral area. The area is then cleansed and the skin is numbed with a local anesthetic. You will receive some mild sedation and pain medication throughout the procedure. You may receive IV antibiotics prior to the injection to prevent any infection. However, it is important that you are able to communicate with your doctor. The needle is inserted under X-ray guidance into the sacral canal. A special contrast dye will be used to verify that the needle is correctly placed and to outline the area of scar tissue. A combination of local anesthetics, anti-inflammatory steroid medicine, an enzyme that helps to absorb the medication, and hypertonic saline to decrease edema of the nerve root is injected. The catheter is then removed. You will be observed in the recovery area for about 2 hours after the procedure.

Be aware that the anesthetic will take several hours to wear off. It is imperative that you have someone to drive you home, as you may experience some temporary loss of sensation and may find your motor coordination a bit awkward or weak. Otherwise, you may resume your regular activities the following day. Prior to resuming any strenuous work or physical activity, please consult your doctor.

It may take several days for the medication to improve some of the symptoms. Most patients report relief within the first several days, although in some cases it may take up to a week or so to notice the benefit. In general, this procedure improves symptoms temporarily, but pain relief can sometimes last for months to years. If necessary, the procedure can be repeated. Because epidural scarring is a difficult problem to treat, some patients may not experience any relief.

In general, this is a safe procedure. Like all injections, there is a very small risk of bleeding, infection, or allergic reaction. Rarely, the spinal sac, which contains the nerves, may be penetrated during a lumbar injection. This rarely may cause headaches. Should you experience one, lie flat in bed and contact your doctor's office for any further recommendations or treatment.

The steroid medication can cause a temporary increase in blood sugar levels. If you are diabetic, you'll need to monitor your glucose levels more frequently for 4-5 days following the injection.

You will be asked to report any allergies at the time your injection is scheduled. This information is necessary for your doctor to know in advance. Substitutions or modifications to the medications may be necessary.

Some other side effects that are uncommon with this procedure are bruising, transient lowering of the blood pressure, transient breathing problems, numbness of the extremities, bowel or bladder dysfunction, paralysis, sexual dysfunction, and possible catheter shearing. If catheter shearing occurs, a small surgical procedure may be required to remove the sheared catheter.

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