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Percutaneous Adhesiolysis

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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.

Keywords

  • Post-lumbar surgery syndrome
  • Epidural fibrosis
  • Lumbar central spinal stenosis
  • Chronic low back pain
  • Epidural injections
  • Percutaneous adhesiolysis

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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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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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