Percutaneous adhesiolysis?

[painfree23]

Received an email today from ASIPP saying Percutaneous adhesiolysis is now covered in all states. Where I trained, we never did this procedure and now in practice I’ve never really done it. Any tips for what exactly this is and outcomes? Worth pursuing after ESIs?

Thanks in advance.

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[lobelsteve]

YMMV. Trained in fellowship. Im sure it was lucrative. Fun to do Not sure it ever worked better than placebo.

An Evidence Based Review of Epidurolysis for the Management of Epidural Adhesions

This review presents epidurolysis as a procedure to alleviate pain and disability from epidural adhesions. It reviews novel and groundbreaking evidence, describing the background, indications, benefits and adverse events from this procedure in an effort ...

www.ncbi.nlm.nih.gov

 

[Ferrismonk]

Also real risk of dural tears.

 

[bedrock]

Also real risk of dural tears.

Exactly. I’d never do it in PP. risk plus it rarely works long term.

 

[Baron Samedi]

Typically done q4weeks in healthy 30 year olds with mechanical low back pain.

 

[painfree23]

Typically done q4weeks in healthy 30 year olds with mechanical low back pain.

What exactly/how much r u injecting?

 

[clubdeac]

Did these in fellowship and then did them on my post lami patients with epidural fibrosis and leg> back pain after failing epidurals and before considering SCS. Rarely saw durable relief and quit doing them when I went into pp. I think I still have my template somewhere which would be interesting to see now

 

[oreosandsake]

people injecting 3% saline, hyaluronidase, NS, high volume, low volume, fast infiltration, slow... you guys going up from caudal space with catheter?

you're supposed to be in the anterior epidural space right?

 

[Baron Samedi]

What exactly/how much r u injecting?

0mL of 0.0%.

 

[painfree23]

Sounds like a bs procedure that no one’s doing anymore. Why’s asipp so exited it’s covered? We need to tell asipp to work on the epidurals/si joint/rf coverage!!

 

[Ronin1]

Makes me lose any respect for the organization advocating for such a sham procedure

 

[buddababa]

Makes me lose any respect for the organization advocating for such a sham procedure

This.

 

[10KHertz]

Perform about 120 per year. Many years. Legit procedure.
Works well. Post laminectomy syndrome with granulation tissue are best candidates. Seen foot drop improve as well as targeted radiculopathy improvement.
Use 600-1000 units hyaluronidase with steroid and saline . Do NOT use hyaluronic acid ( not joking- seen this before) …
If sophisticated use hypertonic and/or leave catheter in for a day. I don’t do this.
Recent study advocating hyaluronidase for simple non post lami radiculopathies . I don’t believe the Medicare lcd allows that yet . Plus I Don’t necessarily agree with premise.

Keep an open mind, plenty of literature out there.

Also too expensive to perform in office with catheter and enzyme cost ($$$$$) . Have to have hospital overcharge and take the overhead burden …

 

[drmamba]

Do you always have hyaluronidase available in clinic? Or do you order it only after a patient agrees to receive the procedure?

 

[jsaul]

This was an asipp procedure touted for many years by the asipp legends of lax, racz, miles day, rasmin Benjamin and Hans hansen..

 

[lobelsteve]

This was an asipp procedure touted for many years by the asipp legends of lax, racz, miles day, and Hans hansen..

Trescott also hired to write a fluff review.
Usual nonsense, this works so we can get paid.

I did read a SIS review in 2017 reporting level 1 evidence and being positive. Unsure if ever published.

 

[10KHertz]

You won’t make much in office with all the catheter , touhy, and med costs (May actually lose money unless cash based). Medicare pays $200 physician fee in hospital as well. So no this isn’t a money making procedure . It’s for your patients that have failed traditional options …

 

[oreosandsake]

You won’t make much in office with all the catheter , touhy, and med costs (May actually lose money unless cash based). Medicare pays $200 physician fee in hospital as well. So no this isn’t a money making procedure . It’s for your patients that have failed traditional options …

before or after stim?

 

[10KHertz]

before or after stim?

For me , I typically offer racz procedures prior to stim routinely. Gives patients an algorithm and options prior to implant . Plus results are pretty good IMO. Nothings perfect of course .

Tell patients as more spread occurs with repeat procedures to expect more leg ‘cramping’ after the procedure for up to a week at times . That way they don’t freak out.

 

[bedrock]

before or after stim?

I’d definitely offer stim first.

 

[10KHertz]

I’d definitely offer stim first.

Some patients are cool with singles and doubles for awhile, before a possible homerun…

 

[Ligament]

I am lost that people are still pushing this procedure...why?

 

[drusso]

I am lost that people are still pushing this procedure...why?

Because of the SOS in HOPD. It's the same reason that a bear craps in the woods.

 

[nvrsumr]

I have a good buddy. Well off Bay Area tech type. Young kids. Classic post lami pain. Scar tissue encircling S1. Thought this would be reasonable to try as he wasn’t excited about a battery…

Don’t think he could find anyone who does these. Any suggestions for a doc near San Fran?

 

[10KHertz]

I have a good buddy. Well off Bay Area tech type. Young kids. Classic post lami pain. Scar tissue encircling S1. Thought this would be reasonable to try as he wasn’t excited about a battery…

Don’t think he could find anyone who does these. Any suggestions for a doc near San Fran?

Have him make a quick trip to Texas
Tech… isn't that Gabor country?

 

[cowboydoc]

Have him make a quick trip to Texas
Tech… isn't that Gabor country?

Yes, set the time machine to Lubbock.

Rittenberg, maybe? He’s at Stanford now.

 

[MitchLevi]

Typical pain medicine thread.

Ppl saying procedure A doesn't work.
Someone else saying it's great.

 

[drrosenrosen]

Typical pain medicine thread.

Ppl saying procedure A doesn't work.
Someone else saying it's great.

You forgot "ppl saying procedure A doesn't work, and you're a bad doctor if you offer it"

 

[10KHertz]

You forgot "ppl saying procedure A doesn't work, and you're a bad doctor if you offer it"

Most divided specialty?