Epidural fibrosis is most frequently seen in patients who have undergone multiple surgical procedures of the spine. Presumably, inflammation and compression of nerve roots by epidural scar or fibrosis (adhesions) are the mechanism of persistent pain following back surgery, a ruptured or herniated disk, or a vertebral body fracture.
Percutaneous epidural lysis of adhesions also referred to as epidural neuroplasty 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. Hypertonic saline and hyaluronidase can be injected through the catheter at the area of fibrosis to mechanically disrupt adhesions and potentially reduce perineural edema.
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.
The patient is placed prone, under intravenous sedation and local anesthesia, whilst using X-ray fluoroscopy, Local anesthetic is injected in and around the sacral hiatus or interlaminar to numb the area. A small needle is inserted through the sacral (caudal) hiatus or interlaminar into the epidural space.
