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Anyone heard of this....?

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:24 AM in Pain Management
With the onset of fairly significant, epidural-fibrosis related pain 15 months post Micro-D (L5-S1), it was recently recommended I look into a procedure called Percutaneous Lysis of Epidural Adhesions. Was wondering if anyone has heard of/experienced this, and if so, what sort of feedback they might have?

From what I gather, based on online reading, they use an instrument called a Racz catheter to both break up scar-tissue/adhesions and deliver anti-inflammatories directly to the affected nerve root. It's performed similiar to an caudal ESI, though saline (and other compounds?) are used to first break up, then shrink the offending material (for more effective delivery of the meds to the nerve).

On paper, this sounds like a godsend, and seems to offer decent prognosis for EXTENDED belief. That said, I've become something of cynic, and it if something seems to good to be true....well......you know....D'oh! On the con-side, 1) it's a fairly new procedure, comparatively (know it's been around for 10 years-ish), and 2) there have been reports for the catheter fraying/breaking while inserted. This has all sorts of warning bells going off in my head, and the tube (while plastic) has some metal portion to it.

I'm trying not to get my hopes up too much, but my pain level has recently shot up significantly, and I don't believe another ESI (what would be my 3rd in this series) is going to offer me much relief (the others haven't done much).

Any input would be GREATLY appreciated.

Alan
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Comments

  • Wasn't sure if this should have been place under injections or pain managment, so I opted for the latter. Ah well, was hoping to find someone who'd been through this, as I'm concerned that anything which sounds too good to be true typically is.....

    Alan
  • I have heard of it. I even asked the Nurse Practitioner at my PMs office. The one thing he said that stuck in my mind was that my scar tissue is bad, yes. But, if I go cutting or burning on it, there is a risk that it will come back much worse than it is, or something like that. It was several months ago (that the conversation occurred) and many drugs ago (my memory is not what it used to be - I blame the medication).

    I know you can find it on the internet because I came to my appointment that day with printed material just in case they hadn't heard of it.

    Anyways, I do sincerely hope you find the relief you are seeking, and need, and deserve. Keep us posted, okay?

    Jeaux
    :B
  • I have also seen numerous members here post the same as Jeaux about the problem with removing scar tissue. I would do lots of research before considering it. Good luck and keep us posted with your decision and results.
  • Hi Alan. I had Percutaneous Lysis of Epidural Adhesions done about 4 months ago. The procedure itself was not a big deal really. They give you a mild sedation and it doesn't take very long to do. I think I was a little sore for a few days, but it didn't slow me down.

    To be honest, I didn't have much luck with it. Before I had this done my major pain was sciatic pain in my right leg and back pain from having had three surgeries on it. After the lysis of adhesions I still had the right leg pain and back pain, but I then started with major left leg pain when I am sitting in the car as a passenger!!!! It hurts so bad that it brings me to tears sometimes. I asked the doctor if maybe the procedure moved scar tissue over to the other side and he said that yes, it was possible.

    Since then I have had the trial for a Spinal Cord Stimulator which went very well. I will be getting the permanent one as soon as insurance allows.

    Please don't let me experience scare you. As we have all learned, all of these procedures that the doctors try work on some of us but not on others.

    I hope it works great on you and that you get to start living painfree!

    Diane
  • but my sister-in-law, who has had horrible pian issues related to a propensity to keyloid scarring, both internally and externally, has found a new, non-invasive method that has worked very well. The majority of her chronic pain is from scar tissues and adhesions.

    Her new PT used something called Kineseo Tape on her a couple of months ago. It has been used in the athletic world for years and if you google it, you can find out lots about it. She was very skeptical about it, because she's had all kinds of modalities to try to help break up her adhesions over the past 12 or 13 yeaes and most gave little or no relief. But, she walked into the PT office a week later and actually hugged her PT. She said it even reduced her external scars by about 75% and she could actually see a huge difference in her range of motion within the first 48 hours.

    If you have a PT that you have used in the past or if your doc can recommend a good one, I would think it would be worth a try. Who knows? It may help a little or maybe a lot. And in my book, since it's totally non-invasive, it's safer to try than a procedure. Either way, I wish you the best of luck. Take care, Mitzi
  • THIS SAME PROCEDURE WAS OFFERED TO ME NOT TOO LONG AGO. THE DOCTOR INVITED ME TO LOOK IT UP ON THE INTERNET, WHICH I DID. I CAME ACROSS THE USUAL, GENERAL KIND OF STUFF AND THEN CAME ACROSS WHAT APPEARS TO BE A CONVERSATION BETWEEN SEVERAL PM DOCS. I SAVED IT AS A FAVORITE AS "EPIDURAL ADHESION TREATMENTS 2004." IN THE APPARENT CONVERSATION, ONE DOC ASKS ANOTHER IF HE/SHE HAS EVER BEEN IN THE OR WHEN THIS SCAR TISSUE IS EXPOSED. ITS LIKE CONCRETE, HE CLAIMS. HOW ARE YOU GOING TO IMPACT CONCRETE WITH A SQUIRT OF SALINE? HE THEN WENT ON TO SAY THAT HE GENERALLY GOES WITH THE SCS FOR PATIENTS WITH SCAR TISSUE ISSUES. IF YOU CANNOT FIND THE PIECE I'VE JUST DESCRIBED PM ME AND I'LL SEE IF I CAN GET SOMEONE TO HELP ME SEND YOU THE LINK.
    SUSAN.
  • It's been a while since I've been on here, as coursework keeps me pretty busy. That said, I certainly appreciate all the feedback.

    I'm still fighting the system with regard to my follow-up treatment. My PM wants to go through with a 3rd round of ESI (next Friday), though the first 2 have shown limited success. This time, however, I'm off the neurontin (nasty stuff), and he's hoping it'll prove beneficial (eh, we'll see).

    My current PM doesn't do the lysis, though he was kind enough to refer me to the one guy in the area who does. You know how it goes, however, now my Primary Care Manager (PCM) has to run it through the system, and MAYBE then they'll approve it. The way the military healthcare system works, my grandkids may be out of college by that point (for reference, I have a 4 and 2 year old now...).

    Concurrently, my PCM wants me to be evaluated by an NS within the military health system (NS whose been seen me the past couple months is out in the civilian world). It's idiotic that I'll have to head all the way down to the Naval Hospital in San Diego, waste an entire day there, for them to tell me precisely what the last NS has already figured out (ie that I'm reherniated at L5-S1, that L5 segment itself is unstable, and that I'll need something more significant surgerywise at some point). Gotta love the military.

    So for now, I go round and round with the system....not really improving (actually increasing in pain level). I keep meaning to jot down some of my thoughts/gripes/concerns in the various categories, but just haven't had time (too many papers due).

    Thanks again for listening everyone!

    Alan
  • Since it's been nearly two months, figured I'd give a brief update now that I'm on holiday break...

    Met with the 2nd NS and he gave me a COMPLETELY different opinion from the first guy. This one says that I do NOT have spondylolytheis, and that my bilateral pain is the function of bilateral foraminal stenosis (which I knew I had). He recommended minimally invasive foraminotomies to widen the canals. It was his opinion that there was no need for a fusion, as my pain generators appear (to him) to be based on neural impingement. While this is good news (and seconded by a friend who is an ortho surg), it leaves me scratching my head how opinions can be SO different. I had no issue with disputing a call, but who do you believe when two capable surgeons tell you two completely different (and contradictory) things. I know there are no concrete answers in this, but I'm mainly confused. Do I get a third opinion?

    On a "positive" note, the insurance finally (and suprisingly) authorized the lysis procedure for me (tentatively scheduled for the Tuesday). While I'd normally be excited about the chance to try something new (after 3, less than effective, ESI's), I'm starting to have 2nd thoughts reading some of the stories I've seen on here regarding the procedure (as well as other studies I've found online). My cousin is a very well reknown phsyiatrist on the East coast, and she has recommended the procedure, but I don't really get a "warm/fuzzy" with this new PM guy. Sounds like he's more in it for a buck, and I'm not sure that coincides with my best interests. That said, he's the only one around here who does the lysis, and I'm not sure that: 1) it's really worth my time (ie don't want to meke this WORSE) and 2) if he's the one who should be doing it. Being in the military traps you in the worst form of HMO, so I have little alternative but to accept the "lowest common denominator" providers that they authorize.

    So, that's where I stand. Not sure whether to even go ahead with this at this point, or if I should consider the foraminotomies (topic for another posting). Any feedback would be fantastic, as I'm becoming a neurotic wreck. Thanks!

    Alan
  • Alan,
    Did you ever go through the lysis procedure? I have read all of the studies about the procedure and of course, the pro and con articles about it, but haven't gotten an overall good feeling about it.
    It's amazing the things that they come up with. My understanding with scar tissue is that surgeons don't want to deal with it because it only creates even more scar tissue, so it makes no sense that some saline and lidocaine is going to break up scar tissue and miraculously cure the pain that we suffer from.
    I had a 2nd surgery , in part to stop my ongoing decline after my first surgery, to try to save some of the nerves that were compressed and damaged from the CES that I developed after the first surgery, and to try to relieve the compression of the spinal nerves . He also tried to remove some of the massive amounts of scar tissue, but he said that while he was able to remove some, it was only going to grow back again and it may make things worse, so he chose to only try to remove a small amount, not near the nerves.
    Anyway, I am curious if you went ahead and how it turned out for you.
    Best wishes,
    Sandi
  • Sandi,

    While I'd been scheduled for the lysis procedure tomorrow (Tuesday), I began having some considerable doubts about it. My cousin (a very reknown PM doc on the East Coast) had been very vocal in her support of lysis, pushing me in that direction as a means of buying time/avoiding surgery/decreasing some of the fibrosis-related pain symptoms. Unfortunately, the more I've researched this (between experiences on this site/others and clinical evaluations/articles) the less confident I am (for a number of reasons). First of all, there seem to be numerous variations of the procedure, ranging from simply injecting the material/saline/etc to manually attempting to break up dislodge the scar tissue. There does not seem to be one encompassing approach to this, and each PM doc seems to use his/her own approach. From what my cousin and I discussed, it sounds like this guy's approach is more a function of what he wants to do (ie his bottom line) than my best interest. I didn't get a "warm/fuzzy" during our first consultation, but (unfortunately) he's the only guy in the area who does it (at least that is covered under the Military's healthcare plan). So, I have no idea as to whether he really knows his stuff, and is looking out for me, or is trying to pad his bottom line.

    Ironically, I got a call from his office manager today, for what I thought was a schedule time for tomorrow's procedure. Turns out that they had not yet received the injectate material, so I'll have to wait until next week before this moves forward. A bit more disconcerting, is the fact that he's no longer willing to use the endoscope in order to go in and break up the adhesions. From what she tells me this procedure is "obsolete", despite the fact they'd initially expressed willingness to give it a try. As I have no idea what what is current and what is "obsolete", there is no way for me to throw the BS flag with any accuracy. From what she tells me, they've had good results injecting this material into the necessary area and shrinking some of the inflamation and adhesions. I find this questionable, but again, cannot say so with any certainty.

    So, whereas I was having growing concern as to whether this was my best bet or not, looks like my decision was made for me (at least temporarily). I'll attempt to find out some more details about what they plan to do, and if things go forward will let everyone know how it works out. At this point, I'll do ANYTHING to knock back this pain and avoid surgery, but don't know how viable this will be....

    Thanks again for touching base, and feel free to drop a PM if time/interest permit...

    Alan
  • Man, I really feel for you! I know how the VA medical treatment is (my 83 year old father who fought in the Navy at Normandy in WW2) decided years ago that he'd rather pay for his insurance than go through all the BS, red tape and all around horrible treatment. As members of our military, veterans should be treated way better than they are.

    The lysis procedure sounds like a God-send, it really does. I wanted it very badly, but the NP explained that messing with scar tissue could make it worse. I wasn't sure if I believed him, since if I have no pain, their clinic misses out on one patient (although there are hundreds ready to step in to my spot in the clinic I'm sure!). You are/were truly in one of those "damned if I do; damned if I don't" situations. I think it was serendipity that the procedure had to be rescheduled. This way you have a little more time to think about it. Too bad you couldn't speak with this doctor's OTHER patients on whom he's performed the procedure - at least hear what they have to say. Does the VA have a website/support forum like this one? Maybe your cousin could help you out as far as this doc's "success rate"?

    I wish you much luck in your decision as well as your journey. Keep us posted, okay?

    Jeaux
  • I know that one risk of messing with scar tissue, is Arachnoiditis http://www.spine-health.com/glossary/a/arachnoiditis

    There are many surgeons that will refuse to do surgery on someone who develops Arachnoiditis, because it will cause the problem to spread.

    Alan,

    Go with your intuition ... go with your "gut".

    "C"
  • Tatonka_usn said:
    This has all sorts of warning bells going off in my head...

    This. I don't recommend doing anything that your gut is telling you not to. I really really trust my gut.

    Good luck,

    Cheri
  • Had same conversatin with one of my pain interventionalists. He said most likely scar tissue would come back and may come back worse. He recommends spinal cord stim if severe symptoms and no surgery needed to fix bones, herniations, etc. If no scs, he will inject a steroid(specifically Kenalog) to help temporarily shrink the scar tissue inflammation but it is not a permanent solution.

    Lots of medical advances have been made, but this scar tissue lysis thing does not seem to be at a point where it is worth the risk.
  • Not whole lot new since my last update, but wanted to thank everyone for the constructive input. This whole ordeal (the last 18+ months) has been very discouraging, and I find myself questioning advice from even respectable/personable physicians....attempting to divine if there are ulterior motives involved. I could go on and on, but suffice it to say I'd give anything to go back to being "normal" (a very subjective term whereas I am concerned....haha!)

    As for now, the injection is currently scheduled for Tuesday. Evidently, the PM doc is going to inject an material called hyaluranidase into the space, with the intention of breaking up/shrinking the adhesions and inflammation. I did a bit of research on this, and it I can't get an accurate read as to whether this is something truly effective. Several of the lysis documents I've come across mention using this (either alone, or in conjunction with steroids, etc) in such a procedure...but the information on the material itself indicates its more usual in assisting other materials by making tissue more permeable. Not sure what the motive is here, but his Office Manager claims that they've had good results with a couple patients (placebo?). Not sure as to the validity of this, but was curious if anyone else is heard of this compound?

    From what I'm told, they do the procedure as a simple injection, using fluoro-guidance. As they aren't using an anesthetic, it's in/out in a short time, with no real side effects. I'm told the only precaution is no heavy lifting, at which point I laughed....having not lifted anything heavy in 18 months. Not sure how long this will take to kick in, or if it will even work, but I'll certainly keep everyone in the loop.

    Anyhow, thanks again for all the support....it's nice knowing there other folks out there who can "feel my pain" (literally and figuratively). Y'all rock!

    Alan
  • 8} Hi everyone. I am scheduled to have a lysis procedure in two weeks, but from what I've just read about the possibility of new scar tissue I may cancel. No one has written anything encouraging. That really scares me!
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