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Epidural Lysis of Adhesion

Dr. Carlos Correia on January 31, 2017 at 11:02 am

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    • Carlos CorreiaDr. Carlos Correia
      Member
      Joined: Jul 28, 2016
      Posts: 2
      January 31, 2017 at 11:02 am #5227
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      I have a patient that needs lysis after L4/L5 surgery, but she has many Tarlov cysts. Is it safe to perform sacral epidural and out a catheter near the root?
      Thank you

      Dr. Carlos Correia

      • Gabor B RaczGabor B Racz
        Participant
        Joined: Mar 28, 2016
        Posts: 30
        January 31, 2017 at 11:06 am #5228
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        I would go with a transforaminal approach at L4-L5 with a catheter, and make sure you cover the painful segments. The danger would be a loculation and/or subdural spread. The cysts may or may not rupture…..wait 20 minutes after the local anesthetic before injecting hypertonic saline….3 infusions, 6-8 hours apart, then watch the patient for the next 4 hours. Read the latest description in the 2nd edition of Techniques of Neurolysis.

        Gabor Racz,MD

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