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Endoscopic Lysis of Adhesions

sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:46 AM in Back Surgery and Neck Surgery
Today I had a caudal endoscopic Lysis of Adhesions and a SI joint block. I'm now 9 months postop PLIF L4-5, and found out 2.5 months ago there was little fusion noted on the xray. What the xray did show was a significant amount of scar tissue. My pain has been so intense, and the last month had worsened.

I finally decided that I was tired of trying to manage my own pain, and sought out help from this PM Doc.

He made a small incision in the caudal area and directed an endoscopy to the area of scarring. He injected dye and IV fluid to try to break up the scarring, and then injected some hyalauronic acid to soften the scarred area that he could not break up. This was done under moderate sedation, and I was fairly comfortable throughout the procedure.

Right before the procedure my pain was an 8, and both my feet were densely numb.

Three hours later, the area is painful, but my numbness has improved some. I was told it may take up to 3 weeks to know the final outcome, and I will have the procedure one more time, to break up the softened scar tissue in a few weeks.

Even though I'm still dealing with an unstable spine due to the fusion issues, hopefully I will have just a little relief from the severe pain. I'm praying hard for success!!!

Please send some prayers my way...the past two months have been miserable.

Thanks guys!! :-)



  • I'm so happy to hear a good chunk of your pain might finally be resolving! You're good people, and I know you have been hurting a lot. Fingers crossed this continues to improve! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Before we realized that my damage was significant enough to warrent a fusion, this procedure was something we were considering.

    At the time, over a year ago, it was not covered by my insurance (BC&BS~POS). We were considering paying cash. Is your insurance covering this? I hope so!

    I will be keeping you in my thoughts and prayers! What a blessing this could be!

    Wishing you a restful and relaxing weekend with minimal pain!

    Hang in there! Shari
  • Brenda and Shari,

    Thank you for the support. I was starting to think there was no hope for me...time will tell, but it is certainly an emotional boost to have an advocate involved in your care.

    Shari, I do not have a clue about the insurance coverage. One would hope that information would be disclosed before having the procedure. Early this AM, we discussed that I've met my deductible for the year...heck, for the next 10 years. Well...it's done now, and absolutely medically necessary. I had to have it done, the scar tissue was extensive, and covering 3 levels. If its not covered, I won't be able to have the second procedure, but I will cross that bridge soon enough. Thanks for the heads up!

    Jim..back at ya with the PM!!

  • This procedure sounds promising and I very much hope that the extensive scar tissue can be broken up.

    Hoping you can get some relief from your pain soon.



    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • sleeprgirl I hope you will get better. Treatment you got is very rare and very advanced. Keep us updated.
  • Lisa,
    I will keep you in my thoughts and prayers. I do hope you will get some relief from these procedures. Best of luck to you and wishing you painfree days ahead.
  • I am so glad to hear that this is working for you. I have been posting similar comments and results under the heading of "Epidural Lysis of Adhesions". Essentially, I had the same procedure as you did. The first time around it helped a little. The second time seems to have had a lasting effect. I have one more round in mid-September and then I need to take a 3 month break (They can only do it 3 times in a 6 month period).

    I'm praying that you have increasingly pleasant results with each visit!!

  • Thank you Trish and Jan...I had so lost hope for ever having decreased pain. It was impossible for me to think of anything but the pain/numb extremities and other symptoms. I could not even go out for lunch without being miserable. It felt like a prison sentence.

    Now there is a ray of hope. At least for this issue. I still have to deal with the non fusion, but I'm wearing my bone stimulator and using nutritional support as well.

    Keano...I agree with you. This is a technically advanced procedure, and my Dr. does have extensive experience, with good results.

    Dave...I'm so glad to here about your good results. Hooray!! Let me know how the third round works for you. Did they use hyalauronic acid during your procedures, and did it work to soften the scarring when they went in the second time?

    I think that it is key to have an accurate and quick diagnosis where scarring is involved. The longer it remains around the nerve root, the tougher the scarring becomes, and of course, the more probability for permenant neuropathy.

    My surgeon never told me about the scarring when I saw him on 6/1. This PM doctor viewed those films, and was able to make the diagnosis.

    The moral to me: When your pain or symptoms remain severe, and you have no diagnosis or treatment plan, get a second opinion...it could be the difference in existing and a more joyful life.

  • Hooray! I am so happy for you! YaY!! :)

    I so, agree, if the pain is horrible, keep searching to find the answer! Our bodys know!

    So happy for you Lisa! :)
  • I can actually feel my feet again. Not that the procedure is without pain...I'm in a significant amount of pain, but it is just surgical pain. My typical pain has improved.

    Oh, I had to see a Pain Psychologist who is my PM's partner. He was terrific, and helped me look at this chronic condition differently. I'm open to all options to help moderate this pain. Seeing your entire life slip thru your fingers is no fun...now I have a few hoops to jump thru for optimal wellness.

  • This procedure has helped already to alleviate some of your pain from the scar tissue. I wish you continues success for your healing and hope it helps to aid in your fusing. TC. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • sleeprgirl said:

    My surgeon never told me about the scarring when I saw him on 6/1. This PM doctor viewed those films, and was able to make the diagnosis.

    The moral to me: When your pain or symptoms remain severe, and you have no diagnosis or treatment plan, get a second opinion...it could be the difference in existing and a more joyful life.


    My surgeon made no comments to me about my cracked vertebra either! On my last appointment when he still didn't comment, my husband and I did. Then all of a sudden "it's no big deal now, we'll see if it fuses on its own!" I think (and it might be human nature?) that they don't want to admit when things go askew? It's bad to me when my hubby and I (non medical types) can SEE it, but he didn't? Umm okay?

    Now your surgeon with the scar tissue. Mine was leery of going back in on this last fusion due to it. I am now figuring he will be even more reluctant to go back in, so I may have to find a new surgeon - would rather stay with him if possible though, as I like and trust him.

    As to not giving up, and getting another opinion, I couldn't agree more! We have to be our own advocate especially now a days! Good for you woman!! I hope today finds you yet improving more. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I'm with you 100%. If I don't fuse, I'm going to get a second opinion before I go back in there. One of my dear friends is an orthopedic hand surgeon. We had lunch on Wednesday, and we both agreed that I certainly am not going to ever have stability without solid bone in there. We also both agreed on the surgeon that I would get a second opinion with. I am using a neurosurgeon now, but this guy is a spine fellowship trained orthopedic surgeon. I gave anesthesia for him in the late 1990's, so I know he is a great surgeon.

    I'm tired of being passive...I have my second wind...and I'm going to press on, baby!!

    Charry, thanks for the email...love your new avatar...I've never been on a motorcycle...wish I did that before the fusion...maybe we can in our next life...teehee!! How are you doing?

  • Lisa,

    My hubby (he's been doing research I guess!! lol!) suggested that *if* a revision is needed, and since more bone would be involved verses nerve issues, I might want to see a spine trained Ortho-surgeon for the second opinion. I saw one of those months ago, and he echoed what my NS said, so I will bet opinion number 3 will be similar.

    I've also shared PM's and chat time with folks who have had the NS vs the OS, and that has helped me. I too like you was 'passive' in the beginning, but as the journey gets longer and deeper into the woods, I am more defensive and pro-active! :) I think that is one of the sad parts of 'growing' with this stuff. Education may be bought (tuition), but experience is earned.

    I'm glad you have such a good friend that understands what's going on, and can aid in your goals of getting things resolved. Looks like you are on your right path in those woods woman!! *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Lisa,
    any chance that u might be able to do a "hello kitty" bone stimulator? My neuro set me up with one because statistically they do help fusion when it's not happening.
    good luck.
  • I've been wearing a bone growth stimulator for the past 72 days...only 168 more days to go..yea! It is an orthofix, and they say that 67% using it for 6-9 months will go on to fuse.

    Flash, when did you have your surgery, and did you begin immediately with the bone stimulator? Have you had any imaging to look for fusion?

    Hope you have wonderful success with yours. I was 6 months postop before they gave me mine, so we will see if it works.

    Take care,

  • Hi Lisa,

    I'm not sure of the exact contents of the injection, but my understanding is that it does include some type of enzyme that is supposed to help "dissolve" some of the scar tissue.

    I couldn't agree with you more about promptly addressing the scar tissue issue. This is where I feel that my NS has done me a great disservice by continuing to do absolutely nothing and telling me to be patient. I assertively pursued a referral to pain management, which was granted, and thus I am now getting some real relief. I'm at almost two weeks after the injection and I'm sustaining the 33% reduction of narcotic usage. I had that pain free weekend which I knew would be temporary, but I'm pleased to see a sustained reduction of pain.

    I hope you have continued relief as well!!

    Take Care,

  • That is so fantastic about your pain reduction. When do you have your next surgery for adhesions.

    Yes, they used hyaluronic acid to soften the remaining tough scar tissue, so it is easy to break up on the next surgery.

    My next surgery is on 9/9. I can not wait to have it done again. Like you, I immediately had a decrease in numbness in my feet...maybe 25%. I am only 3 days out, and I have had surgical pain every evening, but I expected it, due to the extensive adhesions that I had. This pain is different, and my back feels different. I had been telling everyone for the last 4 months that I felt "stuck down around my fusion area". DUH!!! I was!!!

    My PM doc said that he was able to break down about 60% of the adhesions. He said that he would have rather seen me a two months postop, instead of 9 months postop, but was hopeful that he could get to most of the scarring.

    I just hope that I go on to fuse, so I don't have to have a revision fusion, and all that I'm doing now is not futile.

    I see my surgeon on Thurs. When I saw him on 6/1, he told me that I wasn't fusing. When I asked if he would do imaging on my next visit..he said no! I feel like I'm in limbo with his laissez-faire approach. But im stuck with him now because my disability ins. is reviewing my case. It is just a crutial time, and I'm obviously not able to work. I still cannot support my spine; sit/stand more than 30-45 mins, and have been dealing with severe pain. My job is very physical.

    I will just tell you that I had lost hope. We need to see a ray of hope to get thru this journey. My PM doc has given me HOPE!! Now if I could just fuse...WooHoo!!

    Happy Sunday to my Spiney Buds!

  • I started out with the BGS since I am a high risk for non fusion. (obese and cancer drugs)
    I haven't done any pixs yet to look at the fusion, still too early. PlIF L3L4L5 May 2010.
  • Good luck with your fusion...hope that the BGS works out well for you....me too :-)

    Time will tell...it is like a watched pot!!

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