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Caudal epiduralysis is procedure to break up scar tissue in the epidural space by placing a catheter around the nerves. It is a targeted delivery of medications around the irritated and angry nerves by breaking the adhesions around the nerve
A selective group of patients who do not respond to epidural or sleeve root injections may benefit from caudal epiduralysis. Most of these patients have scarring around the spine, especially after the back surgery (Arachnoiditis). Disk herniation can also result in adhesions around the nerve roots.
Epiduralysis is done under fluoroscopy, usually with light sedation. Patient is placed in a prone position and needle is placed through the caudal (tailbone) opening. After the needle placement, a catheter is threaded through the needle toward the irritated nerve roots. The catheter may need to be manipulated several times to open the adhesions.
A small dose of dye is used to identify the adhesions.
The local anesthetics along with steroids are injected in the epidural space through the catheter. It is followed by injection of hypertonic saline. Some physicians use the catheter for three days to inject the hypertonic saline.
A patient will experience some numbness in the legs that usually lasts up to 8-12 hours. I advise my patients not to ambulate for that period to avoid any falls. Patient can have a series of three epiduralysis in a year.