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, 27 (1), 3-15

Epidural Lysis of Adhesions


Epidural Lysis of Adhesions

Frank Lee et al. Korean J Pain.


As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

Keywords: epidural adhesiolysis; epidural lysis of adhesions; epidural neuroplasty; epiduroscopy; failed back surgery syndrome.


Fig. 1
Fig. 1
Sequential antero-posterior fluoroscopic images demonstrating successful epidural lysis of adhesions. (A) Arrow A illustrates the initial contrast injection demonstrating needle entry into the caudal canal. Arrow B shows the radiopaque navigable catheter inserted to the level of hardware at lumbar spine. (B) Initial contrast injection demonstrating filling defects on the left side and cephalad to the hardware, suggesting epidural adhesions. (C) Contrast reinjection after lysis of adhesions demonstrating improved spread cephalad (A) and to the left (B) of the initial injection pattern.

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    1. Nallegowda M, Chiravuri S. Re: Radcliff K, Kepler C, Hilibrand A, et al. Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976). 2013;38:279-91. Spine (Phila Pa 1976) 2013;38:1521. - PubMed
    1. Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med. 2013;38:175–200. - PubMed
    1. Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157:865–877. - PubMed
    1. Manchikanti L, Pampati V, Falco FJ, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine (Phila Pa 1976) 2013;38:157–168. - PubMed
    1. Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011;12:577–606. - PubMed

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