When patient experiences pain in the legs and back, it is because the nerves are inflamed from the disc protrusion and the leakage of disc material. This will cause the surrounding tissue to be inflamed and it will cause scarring as well as the nerve to be stuck down. Epidural adhesiolysis (Neuroplasty) involves freeing the scarred nerve that is stuck down from these surrounding adhesions or scars.

This procedure essentially is like a ballooning of the blocked heart vessels in angioplasty for ischemic heart diseases. Similarly, using a specialized catheter, the procedure involves injection through the spine which can then free up the obstruction and open up the narrowed space leading to a significant reduction in pain experience by the patient.

Patients who may benefit from this procedure would be those suffering from chronic low back pain, spinal stenosis, patients who do not want a surgery, patients with poor surgical risk as well as those who have failed previous back surgeries. Epidural adhesiolysis require only local anesthesia with mild sedation. Hence the risks together with the “down-time” are significantly reduced.

The epidurolysis procedure addresses exact location of pathology in spinal stenosis and post laminectomy pain syndrome patients. The procedure is done in operating room and under Xray (fluoroscopic) control.

A 16 gauge Touhy needle is passed in to caudal epidural route and position of needle is confirmed under fluoroscopy. An epidurogram is done with Inj. Omnipaque 5 to 15 ml, to know the degree and severity of epidural adhesions. It is these adhesions that cause the nerve roots to be stuck down, preventing movement of these nerves, hence causing neurogenic pain.

A guide wire is introduced through Tuohy needle towards lumbar area. Then a steerable catheter (Racz catheter) is passed through needle. A diagnostic epidurogram is performed to visualize the caudal, lumbar and cervical epidural space, nerves and its contents. A chemical hyuronidase is used to dissolve the adhesions. The steerable catheter is rotated side by side to perform adhesiolysis to free any nerves that are stuck down. If necessary, a balloon will be inserted to increase the size of the epidural space and outlet for the nerve. Subsequently, the nerve roots are pulsed with radiofrequency waves to encourage regeneration. The degree of pain relief confirmed by patient also acts as a guide of adequate adhesiolysis.

At the end of the epidurolysis, the inflammatory mediators will be washed away with normal saline and some anti-inflammatory Triamcilone, along with Bupivicaine will be injected.

The epidurolysis has dual effect: one to have adhesiolysis of nerves that are stuck down or scarred by a steerable catheter and second to balloon the stenosed area to increase the area where nerves are free to move.

Epidurolysis is effective in the treatment of spinal pain, spinal stenosis and/or post laminectomy pain and sciatica pain.