Epidural adhesiolysis is used after failed back surgeries. It is a catheterization procedure used to treat chronic back pain by eliminating from the epidural space fibrous tissue that can prevent direct application of drugs to nerves or other tissues.
A needle followed by the advancement of a catheter enters the epidural space either caudally, using an interlaminar approach, or by a transforaminal approach.
Under radiographic control utilizing nonionic contrast medium, local anesthetic and steroid are injected into the epidural space through the catheter. Lysis of adhesions is then carried out by slow and intermittent injections of hypertonic saline. Catheter manipulation and hypertonic saline both aid in adhesion disruption.