Adhesiolysis or Scar Tissue Procedure


What is epidural fibrosis?


Epidural fibrosis is formation of scar tissue inside the epidural space which most commonly occurs following surgery however it may also occur in some patients without surgery.


What is adhesiolysis?


Adhesiolysis is freeing the nerves from the scar tissue with a catheter under x-ray guidance and injecting the medication close to the nerve root so that it will be delivered appropriately to reduce the inflammation.


What is hypertonic saline neurolysis?


Hypertonic saline neurolysis or 10% sodium chloride solution is a concentrated salt solution which is injected into the epidural space into a specific area after scar tissue has been appropriate separated from the nerve roots.


Concentrated sodium chloride solution helps to reduce the inflammation and also cuts down on the swelling of the nerve roots and also may dissolve scar tissue to some extent. 


What happens during the procedure?


The patient is taken into the holding area where an intravenous infusion is started so that small dose of sedation can be given. Following this patient is taken into the operating room and placed on the operating table on their stomach in such a way that physician can best visualize pelvic area for low back.


At this time a small dose of sedation is provided. Appropriate preparation is carried out with sterile technique. The physician numbs a small area of skin with numbing medicine. Following this physician puts a special needle known as RK needle into the caudal epidural space.  Following this contrast is injected in to see how the nerve roots are filling and dispersion of the contrast indicating the scar tissue.  At this time a special catheter which is a spring guided wire known as Racz catheter is slowly passed into the epidural space into the scar tissue area on multiple occasions. After separating the nerve roots from the scar tissue it is positioned so the medicine will be delivered into the area of the irritation of the nerve again additional contrast (dye) is injected to see that nerve roots are clear and filling properly without obstruction of the scar tissue. Following this once it is satisfied that scar tissue has been eliminated a local anesthetic is injected into the epidural space.









































What happens after the procedure?


Following the initial procedure patient is transported to the recovery room and is closely monitored for any complications or side effects. If there is any significant numbness or weakness in the legs no further injections are carried out and the catheter is removed however it there is no numbness or weakness at this time concentrated sodium chloride solution is injected. Following this an anti-inflammatory agent (deposteroid) is also injected. Following this catheter is removed.


Post-procedure Instructions



You were given a number of medications during the procedure. These sometimes include sedatives, narcotics, local anesthetics, steroids, and other medications. Any of these drugs or procedure itself, sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.


What To Do After the Procedure?

Rest for a few hours and use assistance if needed.Resume activity as tolerated, but do not overdo.Resume regular diet.



Do not drive or operate machinery for at least 12 hours.Do not make important decisions for 12-24 hours after treatment.Walk with assistance as long as numbness, weakness, or drowsiness is present.


Notify If You Have:

Excessive or abnormal bleeding / persistent chills or fever over 100°F.If there is a major change in pain pattern or level.



In case of emergency, call (270) 554-8373.If unable to reach physician report to the nearest emergency room and request them to inform physician at Pain Management Center.


Few Other Things:

Take your usual medication.Apply ice massage as instructed; may use heat if ice is intolerable.If IV site becomes painful, place warm towels on the site for 20 minutes2-3 times / day.