Professor Iakiv Fishchenko · Patient information
Epidural adhesiolysis
A catheter procedure that may be considered for persistent radicular pain, including pain after lumbar surgery. We first identify the cause of the symptoms and assess whether the nerve needs direct decompression.
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What is catheter-based epidural adhesiolysis?
The epidural space lies within the spinal canal, outside the dura. Scar tissue and adhesions may form there after surgery or inflammation. During catheter-based adhesiolysis, the doctor advances a special catheter to the planned area under X-ray guidance.
The catheter and injected solutions are used to act on adhesions and deliver medication to the target area. The aim is to reduce pain and related limitations. The approach and medicines are selected individually. Our team uses an inpatient protocol with three days of medication administration.
Adhesiolysis does not remove a herniated disc fragment or widen a spinal canal narrowed by bone. If the symptoms require direct nerve decompression, we discuss the appropriate surgical treatment.
When adhesiolysis may be considered
The procedure may be discussed with selected patients who have persistent radicular pain despite medication, rehabilitation or previous injections. The history of earlier surgery is particularly important: which symptoms were present before it, what changed afterwards, and when the pain returned.
We assess more than the MRI report. Symptoms, muscle strength, sensation, images and the response to previous treatment need to be considered together. A scar seen on MRI does not, by itself, prove that it is causing the pain.
A recurrent disc herniation, stenosis, instability or another source of pain may require a different approach. The term 'epidural fibrosis' in a report is not an automatic indication for a catheter procedure.
How injections, adhesiolysis and surgery differ
An epidural steroid injection delivers an anti-inflammatory medicine to the planned epidural area. Catheter-based adhesiolysis additionally involves advancing a catheter and a planned intervention on adhesions.
Epiduroscopy is a different technique in which an endoscope is used to view the epidural space. It should not be confused with catheter adhesiolysis or with endoscopic discectomy, which addresses confirmed nerve compression. We clarify the name and scope of the proposed procedure before consent to treatment.
What the catheter procedure involves
After examination and review of the images, we plan the target area and approach. Before the procedure, we review medicines, allergies and other medical conditions, and agree on pain relief.
The doctor places the catheter under sterile conditions using X-ray guidance. Its position and the spread of solutions are assessed during the procedure. The use of contrast and any necessary precautions are considered beforehand.
After catheter placement, the patient remains in hospital under the team's supervision. Medication is administered over the next three days according to the schedule below.
Our team's three-day protocol
The three-day protocol refers to three days of medication administration: Tuesday, Wednesday and Thursday. Admission and catheter placement take place the day before, on Monday. The patient remains in hospital under the team's supervision.
Monday
Hospital admission and placement of the epidural catheter under X-ray guidance.
Tuesday
First day of medication administration through the catheter.
Wednesday
Second day of medication administration through the catheter.
Thursday
Third day of medication administration through the catheter.
Catheter removal and discharge take place on Thursday or Friday. The team will agree the day treatment ends, discharge advice and follow-up arrangements with you.
The three medication-administration days and the total hospital stay are therefore different periods. When arranging your visit, plan to stay from Monday until Thursday or Friday.
What results can you expect?
Studies in selected patient groups have reported reduced pain and improved function. However, results and assessments of the strength of the evidence vary: patient groups, protocols and the number of repeat procedures differ. Relief and its duration cannot be guaranteed.
The outcome of a study involving repeat procedures does not mean that a single course provides the same lasting effect. We consider another course according to clinical need and the response to previous treatment.
At follow-up, we assess pain, walking, sleep, daily activities and medication needs. Inadequate or short-lived relief is a reason to reassess the cause of the symptoms and the next treatment step.
Risks, preparation and recovery
Possible risks include infection, bleeding, injury to the dura or nerves, adverse reactions to medicines and insufficient benefit. A catheter procedure also involves risks related to advancing the catheter and maintaining its integrity. X-ray guidance helps monitor the procedure, but does not eliminate all risks.
Tell us about infection, diabetes, pregnancy, allergies and medicines that affect blood clotting. Do not stop these medicines yourself. The doctors will agree an individual safety plan.
Arrange someone to accompany you and transport home in advance. Before discharge, obtain instructions on puncture-site care, activity, driving and follow-up. New or increasing weakness, bladder or bowel problems, fever or a marked deterioration require urgent medical assessment.
What guidelines and reviews say
ASIPP considers catheter adhesiolysis for certain patients after conservative treatment and epidural injections have provided insufficient benefit. Other systematic reviews assess the reliability of the evidence more cautiously because of methodological limitations in the studies. These differences should be considered before deciding on treatment.
The method described here is percutaneous catheter adhesiolysis in the lumbar region. Findings about epiduroscopy are not automatically applied to this technique.
Sources: ASIPP, 2021: guidelines on epidural interventions and catheter adhesiolysis · Randomised trial of catheter adhesiolysis, 2013 · Systematic review of adhesiolysis, 2019: limitations in the reliability of the evidence.
Patient questions
Can adhesiolysis dissolve a herniated disc?
No. It targets adhesions and the delivery of medication to a specific area. The procedure does not directly remove a herniated disc fragment.
Does all pain after surgery require adhesiolysis?
No. We first identify the cause: scar tissue, recurrent disc herniation, stenosis, instability and other pain sources require different approaches.
How long will I need to stay in hospital?
Admission and catheter placement are on Monday. Medication is administered on Tuesday, Wednesday and Thursday. Catheter removal and discharge are on Thursday or Friday. The term 'three-day' refers specifically to medication administration.
Will I need another course of adhesiolysis?
In our team, one course includes three days of medication administration through the catheter. The need for another course is assessed separately, based on the treatment response and clinical situation; it is not prescribed automatically.
How can I find out the cost of adhesiolysis?
A cost estimate is provided after consultation. It takes account of the protocol, materials, medicines and monitoring arrangements. The administrator will confirm which services are included.
Next step
Let's start with your symptoms and MRI
Send your existing scans and a brief treatment history.
We will explain whether an injection or adhesiolysis may be appropriate, or whether another treatment should be discussed. The preliminary scan review is free.