Adhesiolysis

What is epidural adhesiolysis?

The epidural space lies within the spinal canal, outside the dura. Scarring and adhesions may develop there after surgery or inflammation. For adhesiolysis, a special catheter is advanced to the planned area under imaging guidance.

The catheter and injected solutions are used to address adhesions and deliver medication to the target area. The aim is to reduce pain and improve movement and the ability to resume activity. The specific approach, medications and procedure duration are determined by the clinical situation.^[1]

When we consider adhesiolysis

The procedure may be discussed in selected patients with persistent nerve root pain, including after lumbar surgery, when previous treatment has not provided sufficient relief. We take account of the response to medication, rehabilitation and previous injections.^[1]

• Symptoms: where the pain starts and travels, and how it affects walking, sleep and work.
• Neurological status: muscle strength, sensation and signs of nerve compression.
• MRI scans and previous records: scarring, recurrent disc herniation, stenosis and other possible causes of symptoms.
• Previous treatment: what helped, how much and for how long.

We do not recommend adhesiolysis solely because a report mentions a “disc protrusion” or “epidural fibrosis”. We compare imaging findings with your symptoms and examination.

Pain after surgery: first establish the cause

Persistent or recurrent pain after surgery may be associated with different conditions: scarring, recurrent disc herniation, narrowing of the canal, instability or other sources of pain. A scar on MRI does not by itself prove that it is causing the symptoms.^[2]

For the consultation, it is important to know which symptoms were present before surgery, what changed afterwards and when the pain returned. Include the discharge summary and operation report to help us choose the next step.

Adhesiolysis, an injection or endoscopic surgery

These procedures address different problems. An epidural injection delivers medication. Catheter adhesiolysis additionally involves a plan to address adhesions and advance the catheter to the target area. Endoscopic discectomy or decompression allows confirmed nerve compression to be relieved directly.

Adhesiolysis does not remove a herniated disc fragment or resolve bony stenosis. If the cause of your symptoms requires direct nerve decompression, we discuss the appropriate operation. My specialisation is endoscopic spine surgery; we choose the procedure based on your investigations.

Endoscopic disc herniation removal · Endoscopic decompression for stenosis

What is needed before the procedure?

For preliminary review, send the complete MRI study in DICOM format, the report, a description of your symptoms and previous treatment. Include CT scans, X-rays and discharge summaries from previous operations if available.

How to prepare and send CT/MRI scans in DICOM format

Before the procedure, we clarify any other medical conditions, allergies, signs of infection and all medication. It is particularly important to report medicines that affect blood clotting. Their use or any changes are agreed with your doctors; do not stop or restart treatment yourself.

Preparation and anaesthesia are agreed in advance. We also discuss risks: infection, bleeding, injury to the membranes or nerve structures, drug reactions and insufficient benefit. The need for further investigations depends on your health.^[4]

How catheter adhesiolysis is performed

1. We identify the target area. We compare symptoms, examination and imaging, and select the approach.
2. We provide anaesthesia. The patient's position and the procedure arrangements depend on the chosen protocol.
3. We insert the catheter. It is advanced to the planned area under X-ray guidance.
4. We perform the planned treatment and administer medication. The catheter position and spread of the solutions are assessed during the procedure.
5. We monitor you after the procedure. Before treatment is completed, we assess your condition and provide advice for home.

The observation period and timing of catheter removal depend on the protocol and how you feel. Before the procedure, we explain how treatment will be organised in your particular case.

How we assess the effect of adhesiolysis

Randomised studies have assessed catheter adhesiolysis for chronic nerve root pain and pain after lumbar surgery. Pain relief and improved function were demonstrated in selected groups. In one study, treatment over two years involved repeated procedures, so its findings do not mean that a single procedure lasts for two years.^[2][3]

At follow-up visits, we assess not only pain intensity but also walking, sleep, daily activity and medication needs. If relief is insufficient or short-lived, we reassess the cause of the symptoms and the next steps.

Recovery after the procedure

Before going home, you receive advice on the puncture site, medication, activity and follow-up. We increase activity gradually, taking account of your starting condition and the response to treatment.

• Going home: arrange transport in advance for the day the procedure is completed.
• Movement and work: clarify permitted activity, lifting and when to return to your usual activities.
• Driving: you may drive from the day after the procedure is completed, provided you feel well.
• Follow-up: record changes in pain and function to discuss at your next appointment.

New or increasing weakness, urinary problems, fever or a marked deterioration require urgent medical assessment.

Questions about adhesiolysis

Can adhesiolysis dissolve a herniated disc?

No. The catheter procedure targets adhesions and delivers medication to a specific area. It does not directly remove the herniated fragment. We assess whether it needs to be removed based on symptoms, examination and MRI findings.

Does pain after surgery mean that adhesiolysis is needed?

No. First, we assess the possible causes of pain, previous treatment and the condition of the nerve structures. Adhesiolysis is one option for certain clinical situations.

Is a series of procedures needed?

We discuss a repeat procedure based on the response and clinical need. The number of procedures is not determined automatically by the diagnosis alone.

How can I find out the cost of adhesiolysis?

It depends on the chosen protocol, materials, medications and observation arrangements. The plan and cost estimate are clarified after reviewing your investigations and a consultation.