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Percutaneous Adhesiolysis

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Essentials of Interventional Techniques in Managing Chronic Pain

Abstract

Percutaneous adhesiolysis with a reinforced catheter is an effective method for managing recalcitrant low back and lower extremity pain in post-lumbar surgery syndrome, spinal stenosis, and severe degenerative disc disease. The purpose of percutaneous epidural lysing of adhesions is to minimize the deleterious effects of epidural scarring. This scarring can prevent the direct application of drugs used for treating chronic low back and lower extremity pain to the nerves and other spinal tissues. Racz et al. reported the first use of epidural hypertonic saline to facilitate the lysing of adhesions. Since then, the procedure has evolved into a commonly utilized low back pain treatment when a patient’s pain is recalcitrant to conservative management and epidural injections.

Based on multiple high-quality trials, Level II evidence has been demonstrated for adhesiolysis for managing post-surgery syndrome, lumbar central spinal stenosis, and chronic recalcitrant pain from disc herniation.

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Acknowledgments

This book chapter is modified and updated from a previous book chapter, “Percutaneous Lysis of Lumbar Epidural Adhesions” by Laxmaiah Manchikanti, MD, James E. Heavner, MD, and Gabor B. Racz, MD, in the Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Authors and Affiliations

  1. ASIPP and SIPMS, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  3. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  4. Departments of Anesthesiology and Physiology, Anesthesia and Pain Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    James E. Heavner

  5. Department of Anesthesiology, Texas Tech University Health Sciences Center, University Medical Center Hospital, Lubbock, TX, USA

    Gabor B. Racz

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  1. Laxmaiah Manchikanti
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  2. James E. Heavner
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  3. Gabor B. Racz
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Correspondence to Laxmaiah Manchikanti .

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Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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Manchikanti, L., Heavner, J.E., Racz, G.B. (2018). Percutaneous Adhesiolysis. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_14

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