Neuroplasty (Caudal, Transgrade and Transforaminal approach)

Abstract

Neuroplasty or epiduroplasty or epidurolysis or adhesiolysis or Racz procedure is performed to decrease epidural fibrosis and pain related to the compression and irritation of the exiting nerve root. The goal is to get the catheter and medications exactly to the affected nerve root. This is most commonly achieved via the caudal approach, but transgrade or transforaminal approach is also possible. This chapter provides a step-by-step guide on how to perform this intervention safely and shows all the relevant C-arm and needle positions that need to be demonstrated during the Fellow of Interventional Pain Practice (FIPP) exam administered by the World Institute of Pain (WIP). Both native and edited high-quality images are included, so the fluoroscopy anatomy is more easily understood.

Possible complications of the procedures and common reasons for failure at the FIPP exam are also outlined. Evidence for the procedure is provided based on the available literature reviewed by the Benelux section of WIP and also by the American Society of Interventional Pain Physicians (ASIPP).