Adhesions can occur in the epidural space after back surgery Illustration: (c) Anne Asher 2007

Often the invasive nature of back surgery causes adhesions or scarring in the epidural space. Some experts firmly believe this is the reason for pain associated with failed back surgery syndrome.

A new review of medical literature on adhesiolysis, an invasive pain management treatment that breaks apart the scar tissue, has shown that this procedure may have value in relieving low back pain due to epidural scarring. Specifically, the reviewers concluded that in the short term, evidence is strong that it can relieve pain and help improve function. For long term benefits, the evidence is moderate. The review was published in the January 10, 2007 issue of Pain Physician. The review was conducted according to the criteria of the Cochrane Library and the Agency for Healthcare Research and Quality.

As procedures go, adhesiolysis is minimally invasive. It is performed with the use of an endocscope inserted into the epidural space to help the doctor visualize and reach the area she or he is addressing. But adhesiolysis is only given after conservative measures to relieve the back pain have been tried with no luck. Adhesiolysis allows epidural injections to more effectively deliver medication to the area it is needed.

_{Sources:
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 Jan 10 (1) 129-46.
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 Jan;8(1):87-100.}

| What is Scar Tissue? | Failed Back Surgery Syndrome - FBSS | Epidural Space |