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.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. If you take aspirin, ibuprofen, or blood thinners, do not stop taking them without first asking your caregiver.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Dye will be used during your procedure to help caregivers see the epidural space better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• If you are female, tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have blood or urine tests, an electrocardiogram (ECG), chest x-ray, and other tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your procedure:

• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all medicines that you are taking, including the pill bottles, with you to the hospital.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers will insert an intravenous (IV) tube into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your procedure. This caregiver may give you medicine to make you sleepy before your procedure. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (informed consent). It gives your caregiver permission to do the procedure. It also explains the problems that may happen with the procedure, and your choices. Be sure all of your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room and then moved onto a special bed. You will be asked to lie on your abdomen (stomach). Your lower back will be cleaned, and you may be given one or more shots of numbing medicine.
  
  
• During your procedure, a needle will be inserted between the vertebrae (spine) of the lower back. Your caregiver may need to pull out, reinsert, or change the position of the needle to find the epidural area. Dye will be given to make nerves and scar tissues in the spinal area able to be seen. Caregivers will insert a catheter and special tools in the epidural space and move them to the scarred area. An endoscope may be used to show a clear view of the spinal area. The catheter will be moved slowly to free the nerves from the scar tissues.
  
  
• Special fluids will be injected into the catheter to dissolve the scar tissues. A mixture of anesthetic and steroid medicines will also be passed through the catheter. When the procedure is finished, the needle will be 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 will be covered with a cap, and antibiotic medicine and a bandage will be 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.

Contact a caregiver if

• You cannot make it to your procedure appointment on time.
  
  
• You have a fever.
  
  
• Your skin is itchy, swollen, or has a rash.
  
  
• You have questions or concerns about your procedure.

Seek Care Immediately if

• Your legs, feet, or other parts below the waist feel numb, tingly, or weak.
  
  
• Your signs and symptoms are getting worse.

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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.