OrthoNeuroSpine & Pain Institute

Neuroplasty

A Minimally Invasive Way to Relieve Chronic Back Pain

Chronic back pain affects just about everything you do: work, exercise and even rest. After an injury or surgery, scar tissue may form in your back, irritating the nerves. When the nerves become either compressed or stuck in a certain position, it can lead to the swelling and inflammation that causes you pain. People who suffer from these ongoing conditions have an option for relief in a minimally invasive procedure called neuroplasty.

A neuroplasty procedure – sometimes referred to as an epidural adhesiolysis – works to release this pressure in the epidural space in your spine.

Sciatica, which is a nerve issue in the lower spine that causes spasms that radiate into the lower back and legs

Neuralgia, which is a peripheral nerve issue that causes pain spasms in the neck and head

Neuropathy, which may indicate nerve damage through causing pain, tingling, numbness and even motor control problems in your limbs

What Happens During a Neuroplasty Procedure?

The first step in having this minimally invasive spine surgery is determining if you are a good candidate. Sometimes, chronic back pain will not respond to non-surgical treatments like medications or physical therapy. You may qualify for neuroplasty if you cannot have surgery or do not want major surgery for spinal problems.

Neuroplasty may also benefit you if you have:

Pinched or irritated nerves related to sciatica

Bulging, ruptured or degenerated discs

Spinal stenosis

Degenerative arthritis causing facet pain, or facet pain caused by other problems in the joints

Ongoing pain after back or neck surgery

Epidural fibrosis or inflammation

Compression fractures along your spine

If you qualify for this outpatient procedure, your surgeon will administer a local anesthetic to manage any discomfort you may feel, as well as a sedative to help you relax. You will lie face-down, and the surgeon will inject a dye into the epidural space in your back to increase visibility of your scar tissue through an X-ray screen – a process called fluoroscopy.

Through placing a catheter into your spine, the surgeon will deliver a blend of medications around the scar tissue and nerve adhesions. In order to relieve the pressure on your nerves, your doctor may choose to insert a small balloon to widen your epidural space.

Blend of medications to:

Reduce inflammation and edema (swelling)

Increase fluid in the epidural space in your spine, giving your nerves more room

Dissolving nerve adhesions and scar tissue

Temporarily disrupting the nerve feedback, which can resolve chronic pain

Your Recovery

As neuroplasty is an outpatient procedure, you will be able to go home the same day as your surgery. Most patients are able to be up and walking around as soon as the anesthetic wears off. It may be a few weeks until medications take full effect as they work to reduce your inflammation issues and nerve adhesions. Additionally, you may be prescribed some medications to help with inflammation during the recovery period. Your surgeon will recommend physical therapy, which will walk you through certain exercises and stretches that will help to strengthen the muscles in your back.

WHAT IS NEUROPLASTY OR EPIDURAL ADHESIOLYSIS?

After any injury or inflammation or back (spinal) surgery, scar tissue usually forms. Even a slipped disc can irritate the surrounding tissue and cause adhesions or scarring. Excessive scar tissue may press into the nerve, causing inflammation and pain.

Neuroplasty (Epidural Adhesiolysis) is a procedure to remove pressure caused by excessive scar tissue in the epidural space. The epidural space is a thin area between the inside of the spine (disc) and the protective layer around the spinal cord. Neuroplasty/ Epidural Adhesiolysis is done as a day-surgery procedure, under local anesthesia. It is relatively low-risk, with a short recovery time. Generally patients can go home within the same day.

HOW IS NEUROPLASTY OR EPIDURAL ADHESIOLYSIS PERFORMED?

Neuroplasty is similar to the ballooning of blocked heart vessels done on patients with heart problems. You will be given local anesthesia with mild sedation. Then, you will be asked to lay on your stomach for the procedure. The physician will perform the procedure under x-ray guidance that provides a look into the spine. Following that, contrast dye will be injected to highlight the area affected by the scar tissue. A tube (catheter) will then be inserted, from which a mixture of medicine will be administered to decrease the swelling and relieve the pain. If necessary, a balloon may be inserted to create more space around the compressed nerves. The physician may also use pulsed radiofrequency to encourage nerve regeneration if needed.

WHO WILL BENEFIT FROM NEUROPLASTY?

Neuroplasty/ Epidural Adhesiolysis may benefit patients with the following conditions:

Chronic lower back and leg pain

Spinal Stenosis

Patients who had prior back/ neck surgery but still have persistent pain

Patients with herniated disc that is not surgically correctable

Patients who do not want surgery

Patients with high surgery risk

WHAT IS RECOVERY LIKE?

Neuroplasty (Epidural Adesiolysis) is a day surgery procedure. The patient can go home on the same day and the next day patient can get back to work or to their daily activities. The anaesthesia in the legs may last for 24 hours. The patient will not need long duration of rest in bed. Once the anaesthesia wears off, the patient may feel a different type of ache. The original pain may disappear immediately or goes off in a few weeks. It is similar to having a dental procedure. There is no down time to this procedure. After the procedure, the patient would need to start a rehabilitative programme to work and strengthen the surrounding muscles. There would be some medications (not pain killers) to stabilized the surrounding nerves to make them less irritative.

IS THE PAIN RELIEF PERMANENT?

Most of the patients would have LONG TERM relief of 2 years or more. This procedure is similar to ballooning of the heart vessels. If the catheter is able to pass over the narrowing of the spinal canal, the outcomes would be good. However, patients will continue to degenerate and wear and tear will happen. A new area of pain can occur either in a different part or the same part of the spine.

WHAT ARE THE RISKS AND SIDE EFFECTS?

There are almost no risks or complications. The procedures are done under the vision of the Xray, which delineates the safe and unsafe zones. This is 99% safe without any risk of paralysis. There is less than 0.5% chance of nerve injury, infection or bleeding. The procedure is much less invasive than the traditional open surgical approach.