Complications of caudal epidural lysis of adhesions

Epidural lysis of adhesions is a procedure used to treat axial and radicular spine pain. This chapter describes the caudal technique and steps to avoid complications. The goal of the lysis of adhesions procedure is to separate the dura mater from the posterior longitudinal ligament and allow free dural and nerve root movement. The epidural lysis of adhesions procedure is indicated for radicular pain syndromes that have not responded to conservative care including medications and physical therapy. Patient selection is one of the most important factors in avoiding complications. General anesthesia is not indicated for lysis of adhesions but intravenous sedation is required. Positioning is important to maximize the quality of the fluoroscopy, ease and safety of the procedure. The position for the caudal approach is with the patient prone with the hips on a pillow and legs internally rotated. Emergent surgical consultation and antibiotics are indicated if an epidural abscess is suspected.