Percutaneous epidural lysis of adhesions has been developed as a conservative procedure to reduce or eliminate adhesions or fibrosis. A semirigid catheter with a flexible tip is placed into the epidural space to mechanically loosen and/or remove adhesions from the nerve roots.
Technique:
The patient is placed in a prone position, and the sacral hiatus is identified by palpation and fluoroscopy. A 16-gauge, 3{1/2} inch stylet needle suitable for catheter placement is inserted and advanced into the sacral hiatus .
An AP fluoroscopic view is obtained to ensure that the needle tip is midline and positioned slightly toward the side of pain just below the S3 foramen. The location of the needle in the epidural space is verified with the injection contrast under biplanar fluoroscopy, producing an epidurogram that also identifies the area(s) of adhesions .
The catheter is steered gently by alternatively rotating the bent stylet from its proximal end, and advancing or retracting the catheter to lysis the epidural adhesions under a live fluoroscopy. After mechanical lysis of the adhesions with the catheter, an additional 5–10 mL of contrast medium is slowly injected through the catheter to confirm the degree of adhesiolysis. A mixture (Hypertonic saline, Hyaluronidase, local anesthetic and corticosteroid) can be injected through the catheter at the area of fibrosis to mechanically disrupt adhesions and potentially reduce perineural edema. The catheter is carefully removed after finishing the procedure, so as not to shear any part of the catheter as it is withdrawn through the needle.
