An Introduction to Lysis of Adhesions

Many studies have been done to determine what procedures produce the greatest long-lasting effects in reducing chronic back pain. Only two have been identified as being efficacious, Neuroplasty (Lysis of Adhesions) and Neuromodulation. As Lysis continues to be the superior modality for interventional pain, for being a cost effective and long-lasting treatment, much of this procedure has not changed. However, there are a few recent findings that have improved the already remarkable results versus other procedures, namely neuromodulation. These new findings will be discussed in greater detail in the upcoming months. Here are a few of those topics we will discuss: Scarring Triangle We didn’t know until recently, but there is a unique triangular space located medial to the L5 nerve root, lateral to the S1 nerve root, and above the L5-S1 disc. This space measures 0.9 – 1.1 mL, and is large enough to collect disc fragments which can cause L5 neuropathy. Dural Tug There are stages in the formation of epidural adhesions where the scarring will not give you radiculopathy, but if you pull on the dura, it will cause severe pain. This is called the Dural Tug test. It can reproduce a collection of symptoms to determine the area of pain generation and site of pathology. SCS Fade There is an issue that has not been talked about often enough which is call Spinal Cord Stimulation (SCS) Fade. This is when the benefits of neuromodulation become weaker and weaker working and eventually stop over time due to scar formation as the electrodes sticks to the dura and surrounding structures. This can be addressed with Lysis of Adhesions to break up this scar tissue and administer the needed medication to the needed locations around the electrodes.