Cervical epidural lysis of adhesions

Epidural lysis of adhesions is a procedure used to treat axial and radicular spine pain. This chapter describes the cervical technique and steps to avoid complications. The goal of the procedure is to inject therapeutic medications at the site of pathology. The site of pathology is determined by history, physical exam, and imaging studies, including epidurography. Epidurography is performed by injecting myelogram-grade radiopaque contrast into the epidural space to demonstrate areas of epidural adhesions that do not fill with contrast normally. Following catheter placement into the scar area, additional contrast is used to open the epidural space and neural foramina. Using a paramedian approach allows smooth passage of the RX Coudé needle to the midpoint of the interlaminar space. Local anesthetic is injected to provide analgesia and to test for subdural blockade. Complications occur despite following proper procedure and patients need to understand this prior to the procedure.