Epidural Adhesiolysis

WHAT YOU SHOULD KNOW:

• Epidural adhesiolysis is a procedure to treat chronic (long-term) back and leg pain. This pain may be caused by fibrosis (scar tissue) pressing on the nerve roots in the epidural space. The epidural space lies outside the dura mater, which is the strong covering of the brain and spinal cord. Fibrosis usually forms after having back or spinal surgery. Epidural adhesiolysis is done to lyse (dissolve) the scar tissues that press on the nerves. This procedure uses medicines that reach the area to decrease inflammation (swelling) and relieve pain. Epidural adhesiolysis may also be done to treat pain caused by infection or cancer (tumors).
  
  
• During epidural adhesiolysis, fluoroscopy (x-ray with dye) is used to see the nerves and scar tissue. Caregivers will insert a catheter (special tube) and tools in the epidural space and move them to the affected area. Your caregiver may use an endoscope to have a clear view of the spinal area. An endoscope is a metal tube with a light and tiny video camera on the end. When the catheter is in place, a special mixture of anesthetic (numbing) and steroid medicines is injected to the epidural space. After having epidural adhesiolysis, back and leg pain may be relieved, and your quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Having an epidural adhesiolysis carries certain risks. You may have bleeding, infection, trouble breathing, or spinal fluid may leak from the site. Your spinal cord, blood vessels, or nerves may get injured while having the procedure. Your pain may return even after having this procedure. Medicines, including anesthesia, that are used during the procedure may cause an allergy. Steroids may increase your chances of having infections. Those who have blood disorders or who are taking certain medicines are at a higher risk for problems. Epidural adhesiolysis may not be advised for those who are pregnant or have kidney, liver, heart, or lung diseases.
  
  
• Without treatment, the pain that you have may worsen and cause more problems. Your muscles and nerves may become damaged for life. Problems with moving your legs or controlling your bladder and bowel may also result. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your procedure:

• You will be lying on your abdomen for the procedure. Your back is cleaned with soap and water. Sheets are put over you to keep the procedure area clean. Medicines are given to keep you comfortable during the procedure. Your caregiver finds the best place to do the epidural adhesiolysis, and marks the place using a marker. You may be given one or more shots of numbing medicine.
  
  
• During your procedure, a needle is inserted between the vertebrae (spine) of the lower back. You may feel some pushing or discomfort as the needle enters your back. Tell your caregiver if you have pain that does not stop within a few seconds. Your caregiver may need to pull out, reinsert, or change the position of the needle to find the epidural area. Once inserted, dye is given to show the nerves and scar tissues in the spinal area. Your caregiver then inserts a catheter and special tools in the epidural space, and moves them to the scarred area. He may use an endoscope to show a clear view of the spinal area while watching the images on a monitor. The catheter is moved slowly to free the nerves from the scar tissues.
  
  
• Special fluids are injected into the catheter to dissolve the scar tissues. A mixture of anesthetic and steroid medicines is also passed through the catheter. When the procedure is finished, the needle is taken out. Your caregiver may remove the catheter after the procedure or leave it in place for a while. He will use sutures (threads) to keep the catheter from being pulled out. The catheter is covered with a cap, and antibiotic medicine and a bandage are placed over the procedure area.

After your procedure:

You will be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Your blood pressure, heart rate, and ability to move will be monitored closely. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your procedure area keep it clean and dry to prevent infection. A caregiver may remove the bandages soon after your procedure to check your catheter.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.