Procedure Description
Epidural adhesiolysis, also called lysis of adhesions, is a minimally invasive procedure used to break up scar tissue (adhesions) in the epidural space of the spine. This scar tissue can form after spine surgery, disc herniation, or chronic inflammation, and may compress or entrap spinal nerves, leading to persistent pain.
By delivering a combination of medications—such as saline, local anesthetics, corticosteroids, and enzymes—through a specialized catheter, the procedure aims to reduce nerve root irritation, improve mobility, and enhance the effectiveness of future injections.
What It Treats
Epidural adhesiolysis is used for patients with chronic spine-related pain, especially when caused or worsened by:
Failed back surgery syndrome (FBSS)
Epidural fibrosis (scar tissue)
Spinal stenosis
Chronic radiculopathy (pain radiating into the arm or leg)
Recurrent disc herniation
Adhesive arachnoiditis
It is particularly effective when traditional epidural steroid injections have failed or produced only short-term relief.
How It Is Performed
The patient lies face down on a procedure table.
The area over the tailbone or lower back is sterilized and numbed with local anesthetic.
A special catheter (such as a Racz catheter) is inserted into the epidural space, typically through the sacral hiatus or a lumbar entry point, using fluoroscopic (X-ray) guidance.
A small amount of contrast dye is injected to visualize the spread and confirm the presence of adhesions.
A combination of saline, local anesthetic, steroid, and possibly hyaluronidase (an enzyme that helps break down scar tissue) is injected to break up adhesions and reduce inflammation.
In some cases, the catheter may remain in place for 1–3 days for repeated dosing.
The procedure takes approximately 30–60 minutes and is usually performed on an outpatient basis.
Pre-Procedure Instructions
Do not eat or drink for at least 6 hours prior if sedation is planned.
Discuss all medications with your provider—blood thinners may need to be paused several days before the procedure.
Inform your physician if you:
Are allergic to contrast dye, anesthetics, or steroids
Are pregnant or breastfeeding
Have an active infection, fever, or recent illness
Arrange for someone to drive you home, especially if you receive sedation.
Wear loose-fitting, comfortable clothing to your appointment.
What to Expect After the Procedure
You may feel soreness at the injection site for a few days.
Pain relief may begin within a few days and typically improves over 1–2 weeks.
Some patients experience a temporary increase in pain before noticing improvement.
If a catheter is left in place, it will be removed after the treatment course, and you’ll be given instructions on how to care for the site.
Most patients report significant pain reduction and improved mobility, especially when followed by physical therapy.
Contact your provider immediately if you experience:
Fever, chills, or signs of infection
New or worsening weakness, numbness, or bladder/bowel dysfunction
Severe headache or allergic reaction symptoms
Break Through the Scar Tissue—Restore Your Function
At Parkview Spine & Pain, we offer epidural adhesiolysis to help patients with chronic spine pain caused by epidural scarring. If you’ve had limited success with other injections or spine treatments, this advanced technique may offer the next step toward meaningful relief.
👉 Schedule a consultation today to find out if epidural lysis of adhesions is right for you.