Abstract
Percutaneous epidural neuroplasty (epidural neurolysis, epidural adhesiolysis) is a minimally invasive interventional pain procedure for the treatment of refractory chronic low back pain, radicular pain, failed back surgery syndrome, and spinal stenosis. It has been implemented in pain practices worldwide and studied extensively throughout the years since introduction by Dr. Gabor Racz in the late 1980s and often referred to as the “Racz procedure.” It was originally described as a three-infusion procedure over 3 days (inpatient) but has shown efficacy as a single infusion procedure (outpatient). Pathological obstructions and changes of the epidural space have been identified as to pain generators and prevent medications from being delivered to the appropriate space. Hyaluronidase, hypertonic saline, local anesthetics, and ionic contrast have been used in different volumes and doses with one goal in mind. The goal is to identify pathological areas via contrast injection, eliminate the obstruction with hypertonic saline and hyaluronidase, and administer anti-inflammatory medications into the previously obstructed pathological area. Multiple systematic reviews and meta-analysis has shown Level 1 and 2 evidence as a treatment option. It has also been shown to be safe, cost-effective, and efficacious. This procedure can be done at all levels of the spine.
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Morgan, J.L., Day, M.R. (2022). Percutaneous Epidural Neuroplasty. In: Jankovic, D., Peng, P. (eds) Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-88727-8_54
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DOI: https://doi.org/10.1007/978-3-030-88727-8_54
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