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Fluoroscopy Guided

Adhesiolysis

Targeted Treatment for Epidural Scar Tissue and Persistent Nerve-Related Pain

Adhesiolysis, also known as epidural lysis of adhesions, is a minimally invasive pain procedure used in selected patients with persistent spinal or radiating pain that may be associated with epidural scar tissue and adhesions. Fluoroscopy is used to guide the procedure and help the pain specialist deliver treatment to the intended area.

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Fluoroscopy guided epidural adhesiolysis for persistent spinal and nerve-related pain
Treatment Type
Epidural Adhesiolysis
Target Area
Epidural Space
Guidance
Fluoroscopy Guided
Procedure
Minimally Invasive
Epidural adhesiolysis targeting scar tissue around spinal nerve structures

What Is Adhesiolysis?

Adhesiolysis, also called epidural lysis of adhesions, is a minimally invasive procedure designed to address suspected scar tissue or adhesions within the epidural space of the spine.

Epidural fibrosis or scar tissue can develop after spinal surgery and may also occur following inflammation or other spinal conditions. In some patients, these changes may be associated with persistent or recurrent back and nerve-related pain.

During the procedure, the pain specialist uses fluoroscopy, a real-time X-ray imaging technique, to guide a specialized catheter or needle toward the targeted epidural area.

The procedure may involve carefully directing the catheter toward the suspected area of adhesions and administering prescribed medications. Depending on the technique and individual clinical situation, saline or other solutions may also be used to facilitate treatment of the targeted epidural space.

The objective is to improve access to the affected epidural region and deliver medication more specifically around irritated nerve structures. The exact technique and medications used depend on the patient's diagnosis, previous treatment history and procedural findings.

Targets suspected epidural adhesions
Fluoroscopy guided
Minimally invasive approach
Uses targeted catheter access
Designed for selected persistent pain cases
May support rehabilitation
The Procedure

How Does Adhesiolysis Work?

01
Clinical Assessment

Your specialist reviews your symptoms, medical history, previous procedures, treatment response and relevant imaging to determine whether epidural adhesiolysis may be appropriate.

02
Positioning & Preparation

You are positioned appropriately, usually lying face down. The injection area is cleaned and local anaesthetic is used to numb the skin and tissues before the procedure.

03
Fluoroscopy Guidance

Real-time X-ray imaging is used to guide the needle or catheter toward the intended epidural region and help confirm its position.

04
Targeted Epidural Treatment

The catheter may be directed toward the suspected area of adhesions. The specialist then delivers the selected medications or solutions according to the planned technique.

Potential Benefits of Adhesiolysis
Targeted Epidural Access

The catheter can be directed toward a suspected area of epidural adhesions or nerve irritation.

Potential Pain Relief

Selected patients may experience improvement in persistent spinal or radiating nerve-related pain.

Image-Guided Precision

Fluoroscopy provides real-time visualization during needle or catheter placement.

Targeted Medication Delivery

Medication can be delivered toward the intended epidural region rather than relying only on nonspecific medication delivery.

Minimally Invasive

The procedure is performed through a needle and specialized catheter rather than through open surgery.

May Support Rehabilitation

When pain is better controlled, some patients may be able to participate more comfortably in prescribed rehabilitation.

The effectiveness of adhesiolysis varies between patients. It is not a guaranteed treatment for epidural scar tissue or chronic back pain.
You May Be a Candidate If:

Epidural adhesiolysis may be considered for carefully selected patients with persistent spinal or nerve-related pain when epidural adhesions or scar tissue are suspected to contribute to symptoms.

Your doctor may consider the procedure if:

  • You have persistent lower back or radiating leg pain.
  • You have a history of spinal surgery and continue to experience pain afterward.
  • Epidural fibrosis or adhesions are suspected based on your clinical history, imaging or procedural findings.
  • Conventional conservative treatments have not provided adequate improvement.
  • Previous epidural injections have provided limited or temporary benefit.
  • Your pain specialist believes targeted epidural treatment may be appropriate.
Not every patient with chronic back pain or previous spinal surgery has symptomatic epidural adhesions. Careful clinical assessment is required before recommending adhesiolysis.

Conditions Where Adhesiolysis May Be Considered

Adhesiolysis is generally considered only after a detailed evaluation suggests that epidural scar tissue or adhesions may be contributing to persistent pain.

Persistent Pain After Spine Surgery

Patients who continue to experience back or radiating leg pain after spinal surgery may be evaluated for epidural adhesions as one possible contributor.

Epidural Fibrosis

Scar tissue within the epidural space may sometimes be associated with persistent nerve-related symptoms, particularly after spinal surgery.

Radicular Pain

Selected patients with persistent radiating pain caused by irritation of spinal nerve structures may be evaluated for targeted epidural treatment.

Chronic Lower Back Pain

In carefully selected cases, adhesiolysis may be considered when chronic spinal pain is accompanied by suspected epidural adhesions.

Persistent Sciatica

Patients with ongoing sciatic symptoms after previous treatment may undergo evaluation to determine whether epidural scar tissue could be contributing to their symptoms.

Persistent Epidural-Related Pain

Adhesiolysis may be considered when persistent nerve-related pain has not responded adequately to conventional treatment and epidural adhesions are suspected.

Why Choose Vedant Pain Management Clinic for Adhesiolysis?

Detailed Assessment

Your symptoms, previous treatments, surgical history, examination findings and relevant investigations are reviewed before treatment.

Fluoroscopy Guidance

Real-time X-ray imaging is used to guide needle or catheter placement toward the intended epidural area.

Targeted Approach

The procedure is planned around the suspected pain generator and relevant epidural anatomy rather than using the same approach for every patient.

Personalized Care

Treatment recommendations are based on your symptoms, diagnosis, previous procedures and individual clinical needs.

Before Adhesiolysis

Before your procedure, your pain specialist may:

  • Review your symptoms, medical history and previous spinal procedures.
  • Perform a focused physical and neurological examination.
  • Review relevant MRI, CT, X-ray or other investigations when required.
  • Assess whether epidural fibrosis or adhesions could be contributing to your symptoms.
  • Review previous epidural injections and other pain treatments and their response.
  • Review medications, allergies and relevant medical conditions.
  • Discuss expected benefits, limitations, alternatives and possible risks.
  • Provide specific instructions regarding medications, fasting or other preparation when applicable.

Your doctor will determine whether epidural adhesiolysis is appropriate for your particular condition.

Patient consulting a pain specialist before epidural adhesiolysis treatment
After Adhesiolysis

After the procedure, you may be monitored for a short period before discharge. Your recovery instructions will depend on the technique used and your individual medical condition.

You may be advised to:

  • Follow the activity instructions provided by your pain specialist.
  • Avoid strenuous activity for the period recommended by your doctor.
  • Monitor pain, numbness, weakness or other new symptoms.
  • Follow prescribed exercises or rehabilitation when recommended.
  • Attend follow-up appointments to assess your response to treatment.
  • Contact the clinic if you develop concerning or worsening symptoms.

Improvement varies between patients. Some patients may experience changes in pain relatively soon after the procedure, while others may require additional time, rehabilitation or further treatment.

Risks & Considerations

Epidural adhesiolysis is a minimally invasive procedure, but it carries potential risks and complications like other spinal injection procedures.

Possible side effects include temporary soreness, bruising, bleeding, infection, temporary numbness or weakness, headache and medication-related reactions.

Depending on the technique used, there may also be procedure-specific risks involving irritation or injury to nearby neural or vascular structures. Your pain specialist will explain the risks relevant to the planned procedure.

Fluoroscopy uses ionizing radiation. The amount of radiation is minimized while obtaining the imaging required for procedural guidance.

Adhesiolysis does not guarantee permanent removal of pain or prevent scar tissue from developing again. Persistent pain can have multiple causes, and treatment effectiveness varies from patient to patient.

Seek medical attention promptly if you experience severe or worsening pain, significant or persistent weakness, increasing numbness, fever, spreading redness or swelling, severe headache, difficulty breathing, loss of bladder or bowel control, or other concerning symptoms after the procedure.

Frequently Asked Questions

What is Adhesiolysis?
Adhesiolysis, also called epidural lysis of adhesions, is a minimally invasive procedure used in selected patients to address suspected scar tissue or adhesions in the epidural space that may be contributing to persistent spinal or nerve-related pain.
Why is epidural adhesiolysis performed?
It may be considered when persistent back or radiating pain is suspected to involve epidural adhesions, particularly when appropriate conservative treatment and conventional epidural injections have not provided adequate relief.
Is Adhesiolysis performed under fluoroscopy?
Yes. Fluoroscopy is used during commonly performed epidural adhesiolysis techniques to provide real-time X-ray guidance for needle or catheter placement and help confirm the intended location.
Who may benefit from Adhesiolysis?
Carefully selected patients with persistent spinal or radicular pain, particularly those with a history of spinal surgery and suspected epidural fibrosis or adhesions, may be considered for the procedure.
Is Adhesiolysis the same as an epidural injection?
No. A conventional epidural injection generally delivers medication into the epidural space, whereas adhesiolysis may use a specialized catheter to access a more targeted area where adhesions are suspected.
Can Adhesiolysis help after back surgery?
It may be considered for selected patients who continue to experience back or radiating leg pain after spinal surgery when epidural scar tissue is suspected to contribute to their symptoms.
How long does Adhesiolysis take?
Procedure time varies depending on the technique, targeted area and individual clinical circumstances. The complete appointment also includes preparation, imaging and post-procedure monitoring.
How soon can I expect improvement?
The timing of improvement varies. Some patients may notice changes shortly after treatment, while others may require several days or longer. Rehabilitation and additional treatment may be recommended depending on the underlying condition.
Does Adhesiolysis permanently remove scar tissue?
Adhesiolysis should not be described as a guaranteed permanent removal of epidural scar tissue. The procedure aims to address suspected adhesions and facilitate targeted treatment of the affected epidural region.
What are the risks of Adhesiolysis?
Potential risks include infection, bleeding, temporary numbness or weakness, headache, medication-related reactions and irritation or injury to nearby neural or vascular structures. Rare serious complications can occur, and your specialist will discuss the risks relevant to your procedure.

Persistent Pain After Spine Surgery?

Persistent back or radiating leg pain after spinal surgery can have several possible causes. When epidural scar tissue or adhesions are suspected, a detailed pain assessment can help determine whether targeted treatments such as adhesiolysis may be appropriate.
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