Adhesiolysis (lysis of adhesions) is the process of cutting away internal scar tissue that often forms due to inflammation, trauma, infection, or surgical procedures. Adehesiolysis is a minor surgery used to relieve the pain associated with adhesions. For chronic back and neck pain, more than 1.7 million epidural adhesiolysis procedures are performed each year in the U.S.
Adhesions are common among people with low back pain caused by conditions such as spinal stenosis (narrowing of the spinal canal). This is the result of local inflammation, which leads to scar tissue development. Seen in around one-third of patients with failed back surgery syndrome (FBSS), adhesions cause persistent pain, affect mobility, and are often obstacles to injection therapy. In addition, adhesions develop within the small bowel, uterus, and fallopian tubes.
The spine bones (vertebrae) are connected to one another by zygapophyseal joints, also called facet joints. These tiny joints are located on either side of the bone, and they create a space for nerve roots to exit the spine. If adhesions form near the nerve roots, this constricts the nerve, causes irritation, and reduces blood flow. Pain due to adhesions and nerve compression is called radiculopathy.
Before you undergo an adhesiolysis, the doctor will go over the risks and benefits and have you sign a consent for services form. When you arrive at the procedure center, a nurse will start an IV in your arm, and possibly give you a mild sedative. Be sure to have someone with you to drive you home.
This procedure is done under fluoroscopic guidance (real-time x-ray), using an epidural injection. After being positioned on your stomach, the doctor will numb the procedure site with a local anesthetic. Afterwards, he will inject a variety of medications into the adhesion to prevent inflammation, block pain, and dissolve the tissue. Then, the needle is removed, and a dry, sterile bandage is applied.
After the procedure, you will be monitored for around 15-20 minutes. You should take it easy for the rest of the day, and physical activity can be gradually increased as tolerated. You should not soak in a tub or go swimming until the incision has healed.
Adhesiolysis is an effective, safe procedure used to reduce the symptoms of painful internal scarring. Removal of an adhesion will assist with symptoms of back pain due to improvement of nerve root irritation. In a large systematic review of randomized controlled trials, adhesiolysis was found to be superior to epidural steroid injection (ESI) for treating chronic back pain related to adhesions.
Adhesiolysis is a fairly safe procedure, as associated complications are rare. However, these include internal organ injury, development of new adhesions, infection, bleeding, and dural puncture. A common side effect of this procedure is pain at the injection site.
The effectiveness of adhesiolysis is well-documented. Based on one large clinical study, 100% of study participants report pain relief within three months of the procedure, and more than half of these persons reported relief of pain shortly after the procedure. In addition, many studies show strong evidence that adhesiolysis is an effective option for short-term treatment for back pain and radiculopathy.