Scar tissue found in the epidural space can cause chronic low back pain.  The epidural space is a thin space located between the inside of the vertebral column and the protective layer around the spinal cord.   Scar tissue can develop in this space following surgery, injury, or herniated disc leakage.  Scar tissue can restrict the movement of the nerves that can cause inflammation, which causes pain.

How Epidural Lysis can help

Epidural Lysis was developed to decrease the pain of chronic low back due to scar tissue formation.  The idea of Epidural Lysis is to eliminate the effects of scar tissue formation.  Epidural Lysis delivers high concentrations of injected drugs into a targeted area.  Epidural Lysis is known to be used in conditions, such as:

• Pot-Laminectomy Syndrome
• Epidural Adhesions
• Disc Disruption
• Traumatic or Pathologic Vertebral Body Compression Fractures
• Resistant Multilevel Degenerative Arthritis

The Epidural Lysis Procedure

A catheter will be inserted into the epidural space to access the area of the scar tissue.  This area will be injected with a local anesthetic to numb it.  The catheter will enter through the caudal canal to access the area of scar tissue.  The caudal canal is located at the base of the spine, and a catheter is injected through the sacral hiatus.  The sacral hiatus is located near the tailbone and provides a natural entrance to the spine.

With the help of X-ray imaging, the catheter is seen on the monitor and is targeted to the affected nerve root.  Throughout the procedure, the X-ray called a C-arm will monitor the catheter to ensure it is in a safe and effective position.

Each person’s epidural space is unique.  Therefore, determining catheter placement can be difficult.  As a result, general anesthesia is not an option during this procedure because the patient’s participation during the procedure is crucial to reduce the risk of complications.  The patient is asked how certain stimulus feels or to move toes, etc.  A mild sedation can be given to ease anxiety after the catheter has been administered.

After the catheter is placed in position, the medication is injected.  This medication will relieve pain at the source, as well as dissolve the scar tissue.  The medication will appear as a metallic fluid on the X-ray.  It will be injected into the epidural space so that it outlines the epidural space.  This is called epidurogram.  There will then be other fluids injected that will help to relieve pain, dissolve the scar tissue, and reduce inflammation.   These other fluids could include anesthetic, enzymes, and steroid formulations.

After administration of the medication and other fluids, the catheter will be removed and a band-aid will be placed over the injection site.

Epidural Lysis is only Part of the Treatment

These injections are administered to help break up the scar tissue around the nerve root to reduce swelling.   The local anesthetic agent is only a temporary pain relief.  Other steps must be taken to ensure a full recovery after back surgery or an injury and to receive the most benefits from this procedure.  This includes physical therapy and an exercise program.

Risks of Epidural Lysis

As with any procedure there are risks.  The main risks include, but are not limited to:

• Subarachnoid or subdural injection of fluids
• Increased pain
• Paralysis
• Bowel or bladder dysfunction
• Spinal cord compression from the injection of fluids
• Hematoma
• Infection
• Reaction to medications
• Catheter shearing

While this is an option for helping with epidural scar tissue, it is important to remember that Epidural Lysis is only a temporary relief to help a person be able to move forward with a stretching program and physical therapy to ensure the most complete recovery.