PONOS · INTERVENTIONAL PAIN MEDICINE
Lumbar epidural adhesiolysis
A targeted treatment for persistent low back and sciatic pain in selected patients with spinal stenosis or pain following spinal surgery.
A microcatheter provides access to the epidural space, allowing medication to be delivered close to the treatment area under fluoroscopic guidance.
Contact us to book an assessmentExplore the pathwayWhen may it be considered?
Lumbar epidural adhesiolysis, also known as percutaneous epidural adhesiolysis or peridurolysis, may be considered when pain continues to limit daily activities despite appropriate conservative treatment. The decision is based on a consultation, taking symptoms, neurological examination and diagnostic imaging into account.
Lumbar spinal stenosis
In some patients with leg pain and difficulty walking, the treatment may help control the radicular component of their pain.
Read about lumbar spinal stenosis (Italian) →Pain after spinal surgery
It may be considered for persistent pain after surgery, often referred to as failed back surgery syndrome (FBSS), when assessment suggests a treatable epidural or radicular component. Scar tissue on imaging alone does not adequately explain the pain.
Read about pain after surgery (Italian) →The microcatheter: targeted access
When a conventional epidural injection does not adequately reach the affected area, a catheter may allow more targeted delivery. The Guy’s and St Thomas’ NHS patient information explains this rationale and the possible role of fibrosis and adhesions in degenerative conditions as well as after surgery. Suitability is assessed individually and benefit is not guaranteed.
A thin, flexible catheter is introduced into the epidural space, usually through a sacral approach. Fluoroscopy and contrast medium help guide its course and assess fluid distribution.
Treatment close to the nerve root
The catheter allows targeted delivery of the solutions used in the protocol, such as local anaesthetic, saline and corticosteroid. Treatment aims to improve medication distribution and reduce the painful inflammatory component.
Control throughout the procedure
Radiological guidance supports catheter placement. Contrast provides information about epidural spread, which must be interpreted alongside the clinical assessment: it does not establish the cause of pain on its own.
The procedure described uses a percutaneous catheter. It is distinct from radiofrequency treatment and from epiduroscopy, which uses endoscopic visualisation.
From consultation to recovery
1 · Specialist assessment
We review the type of pain, previous treatments and available investigations. Expected benefits, alternatives and treatment limitations are discussed.
2 · Individual preparation
Please report all medication, allergies and medical conditions. Any investigations and the management of anticoagulant or antiplatelet medication are agreed individually. Do not stop treatment on your own.
3 · The procedure
Treatment is performed with local anaesthesia, monitoring and fluoroscopic guidance. It usually takes approximately 30–40 minutes, depending on the anatomical and clinical circumstances.
4 · Observation and follow-up
The pathway described here includes admission for overnight observation. On discharge, you will receive advice about returning to activities and arranging follow-up.
Results and safety
How we assess benefit
A response may develop over the following weeks. Alongside pain, we assess your ability to walk, sleep and resume daily activities.
Effectiveness and the duration of benefit vary. Improvement cannot be guaranteed, and treatment forms part of rehabilitation and overall pain management.
Which risks are discussed?
Local discomfort or a temporary increase in symptoms may occur. Possible complications include bleeding, infection, reactions to medication or contrast, dural puncture with headache, and nerve irritation.
Serious complications, such as epidural haematoma or neurological injury, require careful patient selection and management. Radiological guidance and monitoring help control the procedure but do not eliminate its risks.
Frequently asked questions
Is it the same as an epidural injection?
Both involve the epidural space. Adhesiolysis additionally uses a catheter to reach a selected area and promote targeted distribution of the solutions. The choice depends on the clinical picture and the response to previous treatment.
Does it permanently remove adhesions?
Complete or permanent removal of scar tissue cannot be promised. The meaningful outcome is clinical improvement: less pain and greater independence.
Can it prevent further surgery?
In some cases, it offers an option for pain control. However, the need for surgical assessment depends on the cause of symptoms and any neurological impairment.
Can I go home the same day?
The protocol described on this page includes overnight observation. The timing and arrangements are confirmed during preparation.
What does the research show?
Clinical studies have reported benefits in selected patients with persistent radicular pain. Results must be interpreted in the context of the technique used, patient selection and associated treatments: they do not reliably predict an individual outcome.
Arrange an assessment
For appointment enquiries and clinic locations, please visit the PONOS contact page (Italian).
Contact us to book an assessmentFurther reading and references
Epidural and nerve root injections (Italian) · Persistent pain after surgery (Italian)
Gerdesmeyer L et al. Long-term Efficacy of Percutaneous Epidural Neurolysis of Adhesions in Chronic Lumbar Radicular Pain: 10 Year Follow-up of a Randomized Controlled Trial. Pain Physician. 2021;24:359–367. Read the study on PubMed.