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Epidural Lysis of Adhesions

Reformed1RReformed1 Posts: 257
edited 06/11/2012 - 8:45 AM in Pain Management
I'm posting this under pain management because I recently had the procedure done by a Pain Management doctor.

I had a TLIF at L5/S1 back in January and my pain has never resolved. My NS keeps telling me to be patient, but I keep telling him that my pain doesn't seem to be related to the fusion. My spine seems very stable and my pain is the same as it was prior to the fusion, just more intense. I obtained a second opinion from another NS and he suggested that it might be my S-I (Sacro-Iliac) joint. I requested a referral to Pain Management to see if they could get the root of the issue (no pun intended).

First of all, I have to say that I was very impressed by how the PM doc very carefully listened to my entire history before he made any recommendations. We proceeded with a series of injections in the SI joint, but based upon a recent MRI report plus my clinical symptoms, he urged me to consider the procedure call Epidural Lysis of Adhesions. I had both done at the same time.

Now, I am only two days after the procedure and I'm a little sore from it, as is expected. However, I resumed my PT exercises which were designed to make the nerve root "glide" in and out of the foramina (opening in the vertebra). Prior to this procedure, I wasn't able to tolerate these stretches because the scar tissue was interfering with it and it would make my toes start to tingle. My PT said to stop doing these whenever my toes tingled. Well, after the procedure, I gave it a try again and guess what... no tingling! I think the PM doc successfully freed up the nerve root.

I am aware of other posts in this forum where people shared some unfavorable experiences and their fears about this Lysis procedure. However, I'm optimistic that if I keep up with the PT's recommended "glide" stretches, that I will be able to keep the nerve root free, even if the scar tissue starts to form again. I firmly believe that the key was getting the nerve root freed up in the first place.

I'm not making any recommendations as to how you should apply PT exercises. I just wanted to share a positive experience with a PM doctor, a smooth Lysis procedure, and an optimistic outlook. It could take 2-4 weeks before I know for certain that the Lysis was completely effective. I am also waiting to see if the S-I injections are going to resolve my continuous pain. Again, I'm hopeful. It's been awhile since I've felt like there is hope.

Take Care,


  • If the procedure ends up being successful, you should contact your NS that did your surgery that you found a solution to your post surgery problem. Of course this should be done in a matter so as not to bruise his/her ego. Your solution may help his next patient.

    Just a thought.

  • I checked in with my PM doctor's office about this Lysis procedure and the nurse indicated that they DID NOT free up the nerve root, at least not completely. They said that I may be feeling better due to the medicine that they injected near the nerve root. I look forward to hearing from the doctor directly, because I have a feeling that he did quite a bit of scraping away of scar tissue using the Racz catheter and needle. I don't know for certain.

    Here is a description of the Racz procedure:
    "...a wire catheter is placed through the tailbone and advanced into the caudal canal and into the lumbar epidural space where most scar tissue exists after surgery. The tip of the wire is soft in order to avoid injuring nerve tissue, but is firm enough to help lyse (cut) scar tissue.
    Once the scar tissue is cut or channels cut through the scar tissue with the wire catheter, hyaluronidase (an enzyme), and hypertonic saline (pain reliever and used to help dissolve scar tissue) are injected followed by steroids."

    Source: http://www.pmrehab.com/racz.htm

    In the past I have not responded very well to epidural steriod injections, so I tend to think that my improvement is due to something more than just the injection of medicine. I'll post the facts, or at least the doctor's assessment once I have it. It may not be until mid-August when I see him again. Also, it can take 2-4 weeks to notice an improvement from this procedure.

  • I am very interested in following your situation. I am L4-L5 plif and have been told that my awful pain since surgery is due to scar tissue. At least that's what my ortho surgeon says. My pain management doc says he can't see much scar tissue on my mri. I am having a 2nd mri next week. The first was done 3 months after my surgery. I've read about your procedure and have read pro's and cons on it. Did they do it with small incisions? The doc's I've talked to have been very negative about this procedure but I do know that there is a spine center at Emory in Atlanta who will do it.

    Please keep us posted! I hope you have continued pain relief!
  • It's only been three days since my injections, but I feel wonderful. I know better than to think that this is the end. However, my pain has been so low today (and yesterday) that I hardly even think about taking medication. Too bad for dependency (withdrawal), or I wouldn't have taken a single pill today.

    I'll simply be thankful for however long this lasts. The absence of pain is a wonderful feeling.

    I wish you all had this same feeling right at this moment. Perhaps for whoever reads this, I can pass on a moment of "No Pain" for you. I'll try with all of my heart.

    Take Care,
  • Dave,

    I am soooo happy this round is working so well for you! You do know however, there are some of us that are umm...aaaahhh...Jealous!!! (G) Good for you, enjoy!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I think it's just a matter of time before the injection wears off, but perhaps some real progress was made?

    I certainly don't mean to over-celebrate or rub anyone else's nose in it. Thus, the prayer for you to have at least a few moments of no pain -- maybe a whole day. I mean that sincerely. I wish I could wave a magic wand and have everyone's pain end. I don't think that's realistic, but I do believe that little miracles can easily happen.

    So, if you read this response today, and as your day goes on, please know that I'm asking for someone up above to take your pain away today so that you can join me at this paricularly fortunate moment in time.

    Take Care,
  • Hi Kathy,

    I almost didn't see your post. Sorry about that. I have consulted with a couple of different Interventional PM docs. I think they should just be called Injection PM docs - LOL! I had round 2 of the Lysis procedure on the 11th and I'm already feeling a little improvement, but it will most likely be a week or so before I really notice a benefit. The doctor said that the second round is more effective because each time they do it they cut a little more of the scar tissue than the time before and thus the medicine and enzymes used to dissolve the scar tissue can get in there a little better. This is my understanding, but I am obviously a layperson. My doctor received his MD from Georgetown and his credentials go on and on. He really paid close attention to my history and I feel like he really knows what he is doing.

    I have one more round in a month and then I need to wait three months. They can only do it six times per year (if needed).

    The other thing he did was prescribe Limbrel for osteoarthritis. Check it out. It is a very interesting "medication". I put that in quotes because it is more like a food supplement than a traditional pharmaceutical.

    Please let me know more about your journey with this. I recommend it wholeheartedly, mainly because nothing else is working for me and I'm being pressured to get off of narcotics (the only thing that makes my pain go away).

    Take Care,
  • Isn't pain felief wonderful??? I was so happy to read of the reduction in your pain. I hope it lasts forever. Perhaps this will give hope to a lot of people who suffer with scar tissue pain.
    For years I suffered with savage pain in my feet and legs due to scar tissue brought on by a fusion at L4&L5.
    I am finally free of almost all my pain thanks to a pain pump implant. Every day I thank my lucky stars for the wonderful pain relief this pain pump has given me.
    Best of luck to you Dave. I prey your pain relief continues and you get your life back just as I have.
    Thank you for sharing with us and please keep us all updated.
    Cheers :H
    Patsy W
  • Hi Patsy,

    Thanks for your post! I appreciate it.

    I think I recall reading one of your posts about how effective your pain relief has been with the pain pump and that it used a tiny dose of medicine since it delivers it in a very focused manner. (Do I have that right?)

    I was at a PM doctor office and he was pushing an SCS (Spinal Cord Stimulator) which, at best, he said it would reduce pain by 50%.

    You sound like you have obtained much better pain relief. I'm interested in learning more about the pain pump and how it differs from the SCS approach. Did you look into both of these?

  • I knew it wouldn't last. It's been six days and the pain is starting to return. It's still better than it was, but I imagine that in a few days I will be back to where I was before the injections. I have my last set of injections and Lysis procedure on Sept 13th (happens to be my 24th wedding anniversary as well). I'm hoping that each time we make a little more progress. I'll have to wait 3 months before doing it again.

    The few days without pain was sweet. As I said in the beginning, I knew that this wouldn't last too long. Oh well.

    I know there is some controversy about this Lysis procedure. I'm happy with my doctor and I trust him completely. I would hate to have someone go have this done and then have a bad experience, so PLEASE PLEASE research this carefully and choose your doctor carefully!

    Take Care,
  • I just had my third round of S-I injections and also my third round of epidural lysis of adhesions. I asked more questions today about why did I improve so much last time? Is likely to improve as much or more this time? Do they think it is the S-I joint more than the scar tissue, or the other way around, or is it both?

    I didn't get a lot of answers other than they understand that my pain has improved, so they did both procedures again today. I just don't know where to focus going forward.

    I'm seeing my NS tomorrow and I'm hoping to hear that I'm completely fused. If so, I'm curious to know what he will want to do regarding my treatment plan.
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