The first reported epidural injection for chronic low back pain was performed in 1901. The initial reports of epidurography were in 1921. In ongoing efforts to manage chronic pain, cold hypertonic saline was administered intrathecally in 1967. Subsequently, the use of intrathecal cold saline to relieve pain in cancer patients was reported. The determining factor in the therapeutic effect of cold hypertonic solution was reported as its hypertonicity rather than the temperature. Racz et al. reported the first use of epidural hypertonic saline to facilitate lysis of adhesions and evaluated permeability of the dura in dogs in vitro, demonstrating slow transdural equilibration of hypertonic saline. Hyaluronidase was used in an attempt to alter the rapidity of onset and extent, intensity, and duration of caudal anesthesia. Over the years, multiple investigators have studied the effectiveness of adhesiolysis and hypertonic saline neurolysis with or without hyaluronidase.