Resumen

RACZ, G.  y  FLORES, J. C.. Lisis de adherencias epidurales (Parte 2): Técnica intervencionista. Rev. Soc. Esp. Dolor [online]. 2013, vol.20, n.1, pp.16-24. ISSN 1134-8046.  https://dx.doi.org/10.4321/S1134-80462013000100005.

This technique consists in the use of catheters and special needles to introduce solutions into difficult access sites in order to treat fibrosis or chronic inflammation conditions. Solutions such as hyaluronidase and hypertonic saline solution can be used for the lysis of adhesions caused by the pathology. This paper refers to different alternatives to correctly apply the technique at different spine levels. The technique has evolved from the conventional Tuhoy solution needles with some neurolitic properties to modern mapping needles and catheters that permit to position the desired solution at a distance, close to the desired root and/or foramen. The most frequently affected area is the sacrolumbar segment, but different nosological entities that require clinical or surgical treatments may cause pain in the spinal canal, discs, vegetative structures or roots in any spinal segment. Many of these pathologies, most particularly after surgical treatments, cause inflammatory conditions and epidural adhesions that frequently lead to chronic pain. The pathophysiology and indication of this technique is developed in Part 1 of this publication. This paper describes the techniques to perform lysis of adhesions at all spine levels. A thorough description is made of the caudal, lumbar, thoracic and cervical technique, the solutions administered, the catheters that are used in each case and physical therapy techniques for neural and epidural mapping. All techniques described are illustrated by an "Image gallery" for each procedure. The appropriate use of images is indicated with volume differences in each case. Tips for preventing complications are given.

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