A lumbar epidural lysis of adhesions (LOA) is an outpatient procedure for treating low back and leg pain. This information sheet will explain what it is. Your doctor can explain if it is for you.
What are epidural adhesions?
Adhesions develop scar tissue. They can adhere to the nerve roots so the nerves cannot move as it normally. This can cause severe back and leg pain. The dura is a protective covering of the spinal cord and its nerves. The space surrounding the dura is called the epidural space. When an adhesion forms in the epidural space it is called an epidural adhesion. If that epidural adhesion forms in the lower back area, known as the lumbar region, it is called a lumbar epidural adhesion.
How do epidural adhesions form?
The lumbar area of the spine has five bones, called vertebrae. Soft discs found between these vertebrae cushion them, hold them together, and control motion. If a disc tears, chemicals inside may leak out. If this happens over a long time, an epidural adhesion can form. Adhesions may also develop after surgery. In low back surgery, scar tissue often forms around the nerves of the low back. An adhesion can develop from this scar tissue, preventing movement of the lumbar nerves and causing severe leg pain.
Lysis means breaking up the scar tissue so it no longer causes tissues to stick together. This can relieve your pain.
If you have constant pain in one or both of your legs and you have had it for a long time, you may have an epidural adhesion. If you have had low back surgery you may also have an epidural adhesion. Common tests such as simple MRIs and CT scans may also show disc bulges and nerve root compression, but they do not show scar tissue. Lumbar epidural injections can help to determine what is causing your pain, but an MRI with contrast is usually needed to see scar tissue. The contrast makes scar tissue more visible.
What is a lumbar epidural lysis of adhesions procedure?
In a lumbar LOA procedure, several medications are injected into the epidural space. A local anesthetic (numbing medicine) is used to decrease pain. A corticosteroid (anti-inflammatory medicine) is used to reduce inflammation. Other medicine may be used to help break up the scar tissue. The injections are done through an opening in your tailbone. This is called a caudal epidural injection, and is the easiest and safest way to do this procedure.
What happens during the procedure?
The procedure may start with an IV (medicine given intravenously) to help you relax. A local anesthetic may be used to numb your skin. The doctor will then insert a thin needle directly into the epidural space. Fluoroscopy, a type of x-ray, must be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.
What happens after an injection?
You will be monitored for up to 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions and a pain diary. It is important to fill out the pain diary because it helps your doctor know how the injection is working. It may help to move your back in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day. You may feel immediate pain relief and numbness in your back and leg for up to six hours after the procedure. This tells you the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. This is normal. It may be caused by needle irritation or by the corticosteroid. You can usually return to work the day after the injection, but always check with your doctor.
How long can I expect pain relief?
Sometimes you may have several months of pain relief, and then more treatment is needed. Other times, you will have long-term pain relief. If your pain is caused by injury to more than one areas, only some of your symptoms will be helped by a single procedure.
This is meant only for general information – for information specific to you and your pain
please contact your doctor and he will be able to discuss this with you.
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