[Taiwan Spine Surgery Society 2021 Winter Quarterly Meeting] [Academic Exchange] [Percutaneous Epidural Adhesion Separation/Spinal Catheter] [Postoperative Adhesion Pain Treatment in Spinal Surgery] Successful Case Sharing

Author: Bow Wang, M.D.

Today, I was honored to be invited by senior orthopedic surgeon Lin Zhengli (National Cheng Kung University Hospital) to share my experience with epidural adhesion removal surgery. I took this opportunity to review relevant literature to further refine and improve my knowledge and skills while preparing the presentation.

This conference also provided a deeper understanding of orthopedics in the spine, including cervical spine, adult spinal deformity, and post-laminectomy… This section covers knowledge and management of spinal fasciculations and lumbar disc herniation (FBSS). It aims to help patients pay closer attention to details during image interpretation, diagnosis, and treatment.

With the patient's prior permission, a successful case of epidural adhesion detachment was shared at today's meeting.

Mr. C, 72 years old, underwent multiple spinal surgeries years ago. He subsequently experienced numbness, tingling, and pain in his lower left back and left buttock for over five and a half years. Various treatments were tried without significant improvement. The persistent pain made it difficult for Mr. C to walk and even led to depression.

After various treatments proved ineffective, Mr. C sought treatment at National Cheng Kung University Hospital Neurosurgery. Dr. Huang Zhiyuan diagnosed him with postoperative spinal adhesions and referred him to the Interventional Radiology Clinic for further interventional treatment.

Under epidural angiography, the adhesions were visualized, and an intraspinal catheter and hydrostatic pressure were used for adhesion removal and medication. After treatment, the patient experienced significant improvement in back pain, lower limb pain, numbness, and tingling. He shared his joy with the two doctors during a follow-up visit.

Epidural angiography revealed the adhesions that contrast agents could not pass through, allowing for their removal.

Mr. C shared the differences before and after treatment.

Sciatica is a troublesome problem, typically characterized by severe soreness, numbness, swelling, and pain in the lower limbs, radiating from the buttocks down the leg. It is usually caused by problems in the tissues surrounding the nerve roots, such as the spine, intervertebral discs, and muscles, leading to inflammation of the nerve roots.

Repeated or persistent nerve inflammation can cause nerve conduction disorders and nerve ischemia, resulting in fibrosis, or scar tissue, which causes pain and affects quality of life and work. Generally, the collagen in fibrotic scars is gradually broken down and absorbed by the body, rebuilding and restoring the scar, thus slowly shrinking and softening.

However, some scars contain excessive collagen, forming large, irregular, raised lumps called keloids. These are commonly seen in spines that have undergone multiple surgeries or have experienced repeated inflammation and infection. Symptoms include thigh pain, foot pain or tingling, limping, short walking time, and weakness.

Percutaneous epidural adhesiolysis is performed under X-ray fluoroscopy and local anesthesia. A microcatheter is inserted through the coccygeal foramen into the area of ​​adhesions within the spine to separate them, followed by medication.

National Cheng Kung University Hospital has performed this procedure on several patients with good postoperative results, hoping to provide another treatment option for those unsuitable for surgery or those who have experienced persistent adhesion symptoms despite repeated spinal surgeries.

However, Bow Wang, M.D. reminds patients that special attention should be paid to this treatment in the following situations:

1. Diabetic patients require special attention to wound infection, epidural infection, abscesses, etc.

2. Patients with poor renal function (eGFR < 30) (mL/min/1.73m2)

3. Low platelet count, abnormal coagulation function

4. Patient unable to lie flat

5. Pregnancy

Treatment side effects include possible infection, local hematoma, and bruising at the puncture site; blood clots at the treatment site; and postural headaches due to dural rupture and leakage at the adhesion site.

According to statistics, about 50% to 70% of patients experience symptom relief after minimally invasive adhesion separation via intraspinal catheter, but recurrence may occur 2 to 6 months post-surgery, and patients may need to repeat the same treatment course.

Disposable surgical supplies are not covered by the patient's medical insurance. It is recommended that patients undergo a thorough evaluation and discussion with their doctor to understand the treatment process and related precautions before receiving treatment for better assurance.