Percutaneous epidural adhesiolysis – treatment method for drug-resistant back pain
More details
Hide details
Independent Researcher
Department of Developmental Neurology, Chair of Neurology, Medical University of Gdańsk, Poland
Department of Neurosurgery, Copernicus Hospital Gdansk, Poland
Department of Functional Diagnostics and Kinesiology, Gdansk University of Physical Education and Sport, Gdansk
Department of Psychology and Social Sciences in Medicine and Public Health, Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Mateusz Maciej Węclewicz   

Department of Neurosurgery, Copernicus Hospital Gdansk, Nowe Ogrody 1–6, 80-803 Gdańsk, Poland. Tel.: +48 587 640 563.
Submission date: 2021-05-12
Final revision date: 2021-07-29
Acceptance date: 2021-07-29
Online publication date: 2021-09-27
Pol. Ann. Med. 2021;28(2):250–255
Percutaneous epidural adhesiolysis (epidural decompressive neuroplasty, percutaneous epidural neuroplasty) is treatment method for drug-resistant back pain, including post-surgery syndrome, sciatica or spinal canal stenosis.

To describe the method and outcomes of epidural adhesiolysis.

Material and methods:
The review of the literature on the topic of epidural adhesiolysis.

Results and discussion:
This procedure is usually performed in the lumbo-sacral part of the spine, although it can be also done in the cervical or thoracic parts as well. Its purpose is to administer anesthetic drugs, steroids, saline solution or hyaluronidase into the epidural space via one of the three approaches: caudal, interlaminar and transforaminal. The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials.

The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. When performed by an experienced physician, epidural adhesiolysis is a safe and effective method with infrequent adverse events.

None declared.
None declared.
Manchikanti L, Kosanovic R, Pampati V, Kaye AD. Declining utilization patterns of percutaneous adhesiolysis procedures in the fee-for-service (FFS) Medicare population. Pain Physician. 2021;24(1):17–29.
Brito-Garcıa N, Garcıa-Perez L, Kovacs FM, et al. Efficacy, effectiveness, safety, and cost-effectiveness of epidural adhesiolysis for treating failed back surgery syndrome. a systematic review. Pain Med. 2019;20(4):692–706.
Tymecka-Woszczerowicz A, Wrona W, Kowalski PM, Hermanowski T. Indirect costs of back pain – Review. Pol Ann Med. 2015;22(2):143–148.
Helm S, Knezevic NN. A review of the role of epidural percutaneous neuroplasty. Pain Manag. 2019;9(1):53–62.
Chopra P, Smith HS, Deer TR, Bowman RC. Role of adhesiolysis in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005;8(1):87–100.
Trescot AM, Chopra P, Abdi S, Datta S, Schultz DM. Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update. Pain Physician. 2007;10(1):129–146.
Epter RS, Helm S 2nd, Hayek SM, Benyamin RM, Smith HS, Abdi S. Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician. 2009;12(2):361–378.
Manchikanti L, Pampati V, Cash KA. Protocol for evaluation of the comparative effectiveness of percutaneous adhesiolysis and caudal epidural steroid injections in low back and/or lower extremity pain without post surgery syndrome or spinal stenosis. Pain Physician. 2010;13(2):E91–E110.
Racz GB, Holubec JT. Lysis of adhesions in the epidural space. In: Racz GB, ed. Techniques of Neurolysis. Boston, MA: Springer US; 1989:57–72.
Racz GB, Heavner JE, Raj P. Percutaneous epidural neuroplasty: Prospective one-year follow-up. Pain Digest. 1999;9:97–102.
Manchikanti L, Pampati V, Fellows B, et al. Effectiveness of percutaneous adhesiolysis with hypertonic saline neurolysis in refractory spinal stenosis. Pain Physician. 2001;4(4):366–373.
Shin DA. Percutaneous epidural neuroplasty. In: Kim J-S, Lee JH, Ahn Y, eds. Endoscopic Procedures on the Spine. Singapore: Springer Singapore; 2020:353–359.
Manchikanti L, Bakhit CE. Percutaneous lysis of epidural adhesions. Pain Physician. 2000;3(1):46–64.
Karnezis IA. Minimally invasive therapeutic interventional procedures in the spine: an evidence-based review. Surg Technol Int. 2008;17:259–268.
Manchikanti L, Saini B, Singh V. Spinal endoscopy and lysis of epidural adhesions in the management of chronic low back pain. Pain Physician. 2001;4(3):240–265.
Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, Smith HS. Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician. 2009;12(2):419–435.
Shin J-W, Kim S-H, Choi W-J, et al. Effects of Transforaminal Balloon Treatment in Patients with Lumbar Foraminal Stenosis: A Randomized, Controlled, Double-Blind Trial. https://www.painphysicianjourn.... Accessed March 15, 2021.
Rapčan R, Kočan L, Mláka J, et al. A randomized, multicenter, double-blind, parallel pilot study assessing the effect of mechanical adhesiolysis vs adhesiolysis with corticosteroid and hyaluronidase administration into the epidural space during epiduroscopy. Pain Med (United States). 2018;19(7):1436–1444.
Karm M-H, Choi S-S, Kim D-H, et al. Percutaneous Epidural Adhesiolysis Using Inflatable Balloon Catheter and Balloon-less Catheter in Central Lumbar Spinal Stenosis with Neurogenic Claudication: A Randomized Controlled Trial. Pain Physician. 2018;21(6):593–606.
Anderson SR, Racz GB, Heavner J. Evolution of epidural lysis of adhesions. Pain Physician. 2000;3(3):262–270.
Castillo M, Ortiz O. Handbook of Diagnostic and Therapeutic Spine Procedures. Acad Radiol. 2002;9(12):1437.
Hasenbring M, Kraemer R, Taub E, Theodoridis T, Wilke HJ. Intervertebral Disk Diseases. Kraemer J, ed. Causes, Diagnosis, Treat Prophyl. 2009. doi:10.1055/b-002-59223.
Kehr P. Theodoridis Thedoros and Krämer Jürgen (eds.): Spinal injection techniques. Eur J Orthop Surg Traumatol. 2010;20.
Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: A prospective randomized study. Spine (Phila Pa 1976). 2002;27(1):11–15.
Manchikanti L, Pampati V, Sc M, et al. Role of One Day Epidural Adhesiolysis in Management of Chronic Low Back Pain: A Randomized Clinical Trial. Pain Physician. 4(2):153–166.
Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior HJ. Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: A prospective randomized blinded clinical trial. J Orthop Sci. 2006;11(4):365–369.
Akbas M, Elawamy AR, Salem HH, Fouad AZ, Abbas NA, Dagistan G. Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome. Pain Physician. 2018;21(5):E501–E508.
Choi EJ, Yoo YJ, Lee PB, Kim YC, Lee SC, Moon JY. A retrospective study to evaluate the effect of concentration of hypertonic saline on efficacy and safety of epidural adhesiolysis. Anesth Analg. 2017;124(6):2021–2029.
Kim DH, Abdi S, Schütze G, eds. Transforaminal and interlaminar approaches in epiduroscopy. In: Epiduroscopy. Stuttgart: Georg Thieme Verlag; 2017.
Helm S 2nd, Racz GB, Gerdesmeyer L, et al. Percutaneous and Endoscopic Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis. Pain Physician. 2016;19(2):E245–82.
Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. Pain Physician. 2009;12(6):E355–68.
Jamison DE, Hsu E, Cohen SP. Epidural adhesiolysis: an evidence-based review. J Neurosurg Sci. 2014;58(2):65–76.
Gerdesmeyer L, Wagenpfeil S, Birkenmaier C, et al. Percutaneous epidural lysis of adhesions in chronic lumbar radicular pain: a randomized, double-blind, placebo-controlled trial. Pain Physician. 2013;16(3):185–196.
Manchikanti L, Cash KA, McManus CD, Pampati V, Singh V, Benyamin R. The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial. Pain Physician. 2009;12(6):E341–354. Accessed: 04.04.2021.
Oh Y, Shin DA, Kim DJ, et al. Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study. J Clin Med. 2020;9(4):1144.
Manchikanti L, Rivera JJ, Pampati V, et al. One day lumbar epidural adhesiolysis and hypertonic saline neurolysis in treatment of chronic low back pain: a randomized, double-blind trial. Pain Physician. 2004;7(2):177–186.
Manchikanti L, Knezevic NN, Sanapati MR, Boswell M V, Kaye AD, Hirsch JA. Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Central Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Pain Physician. 2019;22(6):E523–E550.
Park CH, Lee SH, Lee SC. Preliminary results of the clinical effectiveness of percutaneous adhesiolysis using a Racz catheter in the management of chronic pain due to cervical central stenosis. Pain Physician. 2013;16(4):353–358.
Ji GY, Oh CH, Won KS, et al. Randomized Controlled Study of Percutaneous Epidural Neuroplasty Using Racz Catheter and Epidural Steroid Injection in Cervical Disc Disease. Pain Physician. 2016;19(2):39–48.
Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment Options for Failed Back Surgery Syndrome Patients with Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017;42:S41–S52.
Chun-Jing H, Hao-Xiong N, Jia-Xiang N. A aplicação da lise percutânea de aderências epidurais em pacientes com síndrome pós- Laminectomia. Acta Cir Bras. 2012;27(4):357–362.
Manchikanti L, Knezevic NN, Sanapati SP, Sanapati MR, Kaye AD, Hirsch JA. Is Percutaneous Adhesiolysis Effective in Managing Chronic Low Back and Lower Extremity Pain in Post-surgery Syndrome: a Systematic Review and Meta-analysis. Curr Pain Headache Rep. 2020;24(6):1–19.