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Percutaneous Lysis of Adhesions

Percutaneous Lysis of Adhesions (through the caudal canal) is a minimally invasive procedure used to directly observe the inside of the spinal canal.  This allows the physician to inspect the spinal nerve roots for evidence of inflammation, scarring, compression, and/or other abnormalities.  The doctor can remove scar tissue by mechanical means and irrigation.  Therefore, allowing the doctor to administer steroid medications directly on the nerve root.

What are the goals of the procedure?

  • This procedure is to enhance the effectiveness of steroid injections to reduce or eliminate pain.
  • To increase functionality

Before your surgery

Contact your primary care physician to obtain his permission to stop the medication. If you take Lovenox, that medication should be stopped 24 hours before your surgery. Do not eat any solid foods, milk products, orange juice, or candy after midnight the night before your surgery. You may have clear liquids (water, apple juice, Jell-O, soda, clear tea or clear coffee) between midnight and two hours before your arrival time, then nothing. That means no water, ice or chewing gum – nothing!

Day of surgery

  • You will need an adult to drive you home.
  • If you take medicine for your heart, blood pressure, breathing, or seizures, we would like you to take the medicine with a sip of water the morning of surgery.
  • Do not take any other kind of medicine unless the physician tells you to.
  • Do not take any diabetic medicine or insulin.
  • Do not take water pills.
  • If you use inhalers, use them as you normally do and bring them with you.

What to expect during the procedure

  • An IV will be started and you will receive medication to help you relax
  • You will be positioned on your stomach
  • The area of the injection will be cleaned with an antiseptic solution and covered with a sterile drape
  • The doctor will inject a local anesthetic to numb the injection site
  • You will be asked to remain as still as possible
  • You will feel pressure as the doctor inserts the catheter
  • The catheter will be placed under fluoroscopy
  • A contrast will be injected to view the area that needs to be treated
  • A stylet will be inserted through the catheter to break up the scar tissue. You will have some discomfort for a brief period.
  • The catheter will remain in place and you will be moved to the recovery area
  • Your doctor will administer steroid medication into the catheter
  • After a brief recovery period you will be discharged
  • The procedure takes approximately 20-30 minutes

What to expect after your surgery

  • No driving until the next day.
  • We would like you to take it easy for 3-4 days and then you can resume your normal activity.
  • Keep the site open (no dressings), clean, and dry
  • If you should develop a fever or any signs of infection, increased pain, numbness in your legs, or a severe headache please contact us at 570-271-6621.  After hours you can call 570-271-6211 and ask for the chronic pain physician on call.
  • You will receive a return appointment for Pain Therapy one month after your surgery.