Abstract
Percutaneous epidural neuroplasty (PEN) is a minimally invasive intervention that aims to reduce adhesion-related pain by detaching the adhesions and delivering drugs to the pain-provoking epidural space. Pain may be alleviated by in situ adjuvant treatments with PEN technique. In this section, we covered technical aspects of the PEN, including details about the anatomy, needle navigation, fluoroscopic guidance, and medications. Dural adhesion can be resolved with mechanical shear stress, cutting with hydrostatic pressure, and chemical adhesiolysis. Following a PEN procedure, local anesthetics and steroids may be injected to the spinal canal. Because each patient’s situation is unique, different strategies may be required to detach the pain-provoking lesions. Technical failure may lead to complications including dural puncture, epidural hematoma, and neural injury. Compared to the open adhesiolysis of the spinal canal, PEN is a less invasive option that causes less post-operative pain.And it is better than the simple administration of pain-relieving agents over the epidural space of cervical, thoracic, and lumbosacral areas. It is recommended for patients with various spinal diseases, such as post-spinal surgery syndrome, herniated intervertebral discs, spinal stenosis, and any epidural adhesions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Racz GB, Edward NC. Techniques of neurolysis. Springer; 2016.
Manchikanti L, AD Kaye, Falco FJ, Hirsch JA: Essentials of interventional techniques in managing chronic pain. 2018.
Shin DA. Endoscopic procedures on the spine. Springer; 2020.
CPT 2022 professional edition: American Medical Association. 2021.
Lee N, Ji GY, Yi S, Ha Y, Shin DA, Kim KN, Ha Y, Oh CH. Finite element analysis of the effect of epidural adhesions. Pain Physician. 2016;19(5):E787–93.
Raj PP, RG B. Techniques of Neurolysis. Boston, MA: Springer US; 1989.
Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, deTribolet N. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery. 1996;38(4):855–61. discussion 861–853
Miyamoto H, Aoki M, Hidaka E, Fujimiya M, Uchiyama E. Measurement of strain and tensile force of the supraspinatus tendon under conditions that simulates low angle isometric elevation of the Gleno-humeral joint: influence of adduction torque and joint positioning. Clin Biomech (Bristol, Avon). 2017;50:92–8.
Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract. 2010;10(1):18–24.
Manchikanti L, Pampati V, Fellows B, Rivera J, Beyer CD, Damron KS. Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial. Pain Physician. 2001;4(2):153–66.
Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. Pain Physician. 2009;12(6):E355–68.
Manchikanti L, Rivera JJ, Pampati V, Damron KS, McManus CD, Brandon DE, Wilson SR. One day lumbar epidural adhesiolysis and hypertonic saline neurolysis in treatment of chronic low back pain: a randomized, double-blind trial. Pain Physician. 2004;7(2):177–86.
Manchikanti L, Cash KA, McManus CD, Pampati V, Singh V, Benyamin R. The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial. Pain Physician. 2009;12(6):E341–54.
Ji GY, Oh CH, Won KS, Han IB, Ha Y, Shin DA, Kim KN. Randomized controlled study of percutaneous epidural Neuroplasty using Racz catheter and epidural steroid injection in cervical disc disease. Pain Physician. 2016;19(2):39–48.
Choi SS, Joo EY, Hwang BS, Lee JH, Lee G, Suh JH, Leem JG, Shin JW. A novel balloon-inflatable catheter for percutaneous epidural adhesiolysis and decompression. Korean J Pain. 2014;27(2):178–85.
Shin JW. Methods for Executing the ZiNeu Series Catheter Procedure. In: Shin JW, editor. Spinal Epidural Balloon Decompression and Adhesiolysis. Singapore: Springer Singapore; 2021. p. 55–100.
Oh Y, Shin D, Kim D, Cho W, Na T, Leem J-G, Shin J-W, Kim D-H, Hahm K-D, Choi S-S. Effectiveness of and factors associated with balloon Adhesiolysis in patients with lumbar post-laminectomy syndrome: a retrospective study. J Clin Med. 2020;9:1144.
Shin JW. Spinal epidural balloon decompression and adhesiolysis. [S.l.]. Singapore: Springer Verlag; 2021.
Moon BJ, Yi S, Ha Y, Kim KN, Yoon DH, Shin DA. Clinical efficacy and safety of trans-sacral Epiduroscopic laser decompression compared to percutaneous epidural Neuroplasty. Pain Res Manag. 2019;2019:2893460.
Cho PG, Ji GY, Yoon YS, Shin DA. Clinical effectiveness of percutaneous epidural Neuroplasty according to the type of single-level lumbar disc herniation: a 12-month follow-up study. J Korean Neurosurg Soc. 2019;62(6):681–90.
Park JH, Ahn Y, Choi BS, Choi KT, Lee K, Kim SH, Roh SW. Antithrombotic effects of aspirin on 1- or 2-level lumbar spinal fusion surgery: a comparison between 2 groups discontinuing aspirin use before and after 7 days prior to surgery. Spine (Phila Pa 1976). 2013;38(18):1561–5.
Manchikanti L, Bakhit CE. Removal of a torn Racz catheter from lumbar epidural space. Reg Anesth. 1997;22(6):579–81.
Kim TH, Shin JJ, Lee WY. Surgical treatment of a broken neuroplasty catheter in the epidural space: a case report. J Med Case Rep. 2016;10(1):277.
Kang JH, Choi H, Kim JS, Lee MK, Park HJ. A sheared Racz catheter in cervical epidural space for thirty months: a case report. Korean J Anesthesiol. 2015;68(2):196–9.
Felice K, Schumann H. Intravenous lipid emulsion for local anesthetic toxicity: a review of the literature. J Med Toxicol. 2008;4(3):184–91.
Ok SH, Hong JM, Lee SH, Sohn JT. Lipid emulsion for treating local anesthetic systemic toxicity. Int J Med Sci. 2018;15(7):713–22.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Yoon, SJ., Shin, D.A. (2023). Percutaneous Epidural Neuroplasty. In: Ahn, Y., Park, JK., Park, CK. (eds) Core Techniques of Minimally Invasive Spine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-9849-2_26
Download citation
DOI: https://doi.org/10.1007/978-981-19-9849-2_26
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-19-9848-5
Online ISBN: 978-981-19-9849-2
eBook Packages: MedicineMedicine (R0)