The epidural space is the space between the bones of the spinal cord and the outer limit of the spinal canal. This space contains fat cells, blood vessels, lymphatics, and spinal nerve roots. When scar tissue forms along the spinal column, it sometimes presses on the nerves in the epidural space and causes severe pain in the legs and back. Scarring of the spine is usually related to a condition called failed back surgery syndrome. Failed back surgery syndrome refers to chronic pain caused by laminectomies and other spinal surgeries.
Overview Of The Procedure
Before epidural adhesiolysis surgery begins, the patient is sedated and a local anesthetic is applied to the treatment area. The pain management physician inserts a needle between the affected vertebrae and injects a dye into the area. The dye is used to make scar tissue more visible during X-ray scans. Using the scans as a guide, a small catheter is inserted into the epidural space to separate the nerves from the scars. A fluid may be injected to dissolve scar tissue, and a steroid injection serves to suppress pain and inflammation. After the surgery, the catheter is secured with stitches and covered with a cap and bandage. The catheter is removed after further treatments and steroid injections.
Patients should not drive themselves home after epidural adhesiolysis, and physical activity should be avoided until the pain subsides. If walking and standing are difficult, a cane or crutches may be helpful for a few days. Pain medications may be prescribed for severe pain. Antibiotics should also be taken to reduce the risk of bacterial infections. Physical therapy will increase mobility and reduce pain during and after the recovery period.
Benefits Of Epidural Adhesiolysis
Epidural adhesiolysis is often extremely effective for patients who have failed to respond to less invasive treatments. Its low cost and relatively short recovery time make it preferable to other surgeries in many cases. The removal of adhesive scars allows the spine to move freely, and patients typically benefit from increased mobility. If the scars were previously pressing on nerve roots, the patient should notice a drastic reduction in low back and leg pain. The injection of anesthetics into the epidural space will also help to reduce spinal pain.
Risks Associated With The Treatment
The catheter and needles used during epidural adhesiolysis rarely rupture the dura mater, a thin membrane that surrounds the brain and spine. Puncturing of the dura membrane can lead to symptoms such as nausea and headaches. The areas around injection sites are subject to bruising, bleeding, and infections although these are infrequent. The use of fluids in the epidural space has the potential to put excessive hydrostatic pressure on the spine. If the catheter is damaged during or after the procedure, the pieces may be left inside the patient’s body. The injected steroid sometimes leads to weight gain and other side effects, and some people may have severe allergic reactions to the steroid or X-ray dye.