Epidural Neuroplasty

What should I expect from this procedure?

This procedure is otherwise known as epidural lysis of adhesions or the "RACZ" procedure named after the physician who first performed the procedure.

It has been found that after trauma or surgery of the spine, scar tissue forms around the nerves in the spinal canal. It has also been shown that the presence of scar tissue compounded pain associated with nerve roots by adhering the nerve roots to one position and thus increasing the nerve root to tension or compression. This active insult to nerve roots cause significant intraneural edema, or swelling in the nerve root itself. Pain can also result from the nerve endings found throughout the spinal canal and associated structures.
Epidural Neuroplasty or Epidural Neurolysis is a procedure to help identify significant epidural adhesion and fibrosis, whether from trauma to the spinal structures or from corrective surgery itself. By using 1) anti-inflammatory medication, 2) medications aimed at reducing edema, 3) local anesthetics to block nerves that carry pain information to the brain, and 4) fluid and special medications to break down scarring around the spinal nerves and structures. There is rationale to target the anterior epidural space.
The procedure itself is done as an outpatient, under light sedation and x-ray guidance. There are several variations on the procedure, some involving inpatient admissions and several different medications. Your physician will discuss this with you and how it applies to your particular situation. Several different approaches to the scarring are possible, sometimes utilizing both approaches at the same time. During the lysis of the adhesions, pain can sometimes be felt into the back, buttocks or into the legs. This is due to the pressure of the scarring on the nerves.
With treatment that includes hyaluronidase, up to 80% of patients report some pain relief, with a significant number reporting long-term pain relief.

What possible side effects might I see?

Occasionally postoperative pain can be felt for up to 1 week. With the reduction of pain, your physician will occasionally start physical therapy.
As with any procedure, there are potential complications. The most common complication of Epidural Neuroplasty is unintended subarachnoid injection. Others may include bleeding, infection, bladder dysfunction, and transient motor weakness. There is a small chance of hypersensitivity to hyaluronidase, which can be used during the treatment.