Epidural Neuroplasty
A catheter-guided treatment that delivers medicine to nerves trapped in scar tissue, most often for leg and back pain that continues after spine surgery.
What is epidural neuroplasty?
After spine surgery, or with long-standing stenosis, scar tissue can form in the epidural space around the spinal nerves. This scarring (epidural fibrosis) can tether irritated nerves and keep medicine from a standard epidural injection from reaching them.1,2
Epidural neuroplasty, also called percutaneous adhesiolysis or the Racz procedure, uses a thin, flexible catheter steered under X-ray to the scarred area. Medicines are then delivered right where the nerve is trapped, to help loosen scar tissue, reduce inflammation, and calm the nerve.1
How it works
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Map the scar
Contrast dye under live X-ray shows where medicine flows freely and where scar tissue blocks it.
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Steer the catheter
A thin, flexible catheter is guided through a small needle to the blocked area around the painful nerve.
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Deliver medicine
Medicines such as numbing medicine, a steroid, and sometimes an enzyme or salt solution that helps loosen scar tissue are delivered to the nerve.
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Home the same day
The catheter is removed, a small bandage is applied, and you go home with a driver.
- Targets trapped nervesReaches areas a standard epidural injection may not, because of scarring.
- No implantThe catheter is removed before you leave.
- OutpatientDone in about 30 to 60 minutes with local numbing and sedation as needed.
- After surgery optionsAn option for persistent leg pain after back surgery when another operation isn’t the answer.
What the evidence shows
Studied in randomized trials
A 2023 review of nine randomized trials found significant improvement in pain and function at 12 months, along with reduced use of pain medication, in people with chronic low back and leg pain that hadn’t responded to conservative care and epidural injections.1
Best studied after back surgery
Most trials included people with ongoing pain after lumbar surgery. Evidence for stenosis and disc herniation is more limited, and there are no placebo-controlled trials.1,2
What to expect
Before your procedure
Tell us about your medications, especially blood thinners, and any allergies to contrast dye or medicines. We’ll tell you whether any medication should be paused. Please don’t stop one on your own.4 Plan on a driver.
During your procedure
You lie face down. The skin over the tailbone or low back is numbed, and sedation keeps you comfortable. You may feel pressure, or a reproduction of your usual leg pain as medicine reaches the nerve.
After your procedure
Soreness for a few days is common, and your legs may feel numb or heavy for several hours. Steroid effects such as higher blood sugar or flushing can last a few days. We’ll check your progress at follow-up.
Is epidural neuroplasty right for you?
It may be an option if
- You have leg pain, with or without back pain, that continues after lumbar spine surgery
- Epidural steroid injections helped only briefly or not at all
- Physical therapy and medications haven’t provided enough relief
- Imaging doesn’t show a problem that needs another operation
Another approach may fit better if
- You have new or worsening weakness or trouble with bladder or bowel control, which needs urgent evaluation
- You have an active infection or a bleeding problem that can’t be managed safely
- Your pain comes mainly from another source, such as the facet or sacroiliac joints
Common questions
Will it remove the scar tissue?
Not completely. The goal is to loosen scar tissue around the nerve enough for medicine to reach it and to reduce irritation, which can relieve pain for months.
How long does relief last?
It varies. In clinical trials, many patients still had improvement a year later, and the procedure can be repeated if it helped.1
Is this an alternative to more surgery?
For some people, yes. When imaging doesn’t show a problem that another operation would fix, neuroplasty is one of several options, along with spinal cord stimulation.
Will insurance cover it?
Coverage varies, and some plans don’t cover adhesiolysis.2 Our staff will check your benefits and request any required prior authorization before scheduling.
Talk with a specialist about pain after back surgery
Our physicians will review your history, imaging, and prior treatments to decide whether epidural neuroplasty, or another treatment, is the best fit for you.
New pain management patients need a referral. Your provider can fax it to 870-706-2428.
Risks
Possible side effects include soreness, temporary numbness or weakness in the legs, headache, bleeding, infection, catheter shearing (rare), and steroid side effects such as temporary high blood sugar. Rarely, serious complications such as nerve or spinal cord injury can occur.3 Your physician will review the risks with you before your procedure. Individual results vary.
Sources
- Manchikanti L, et al. Efficacy of percutaneous adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis of randomized controlled trials. Pain Ther. 2023;12(4):903-937. doi:10.1007/s40122-023-00508-y
- Manchikanti L, et al. Is percutaneous adhesiolysis effective in managing chronic low back and lower extremity pain in post-surgery syndrome: a systematic review and meta-analysis. Curr Pain Headache Rep. 2020;24(6):30. doi:10.1007/s11916-020-00862-y
- U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. 2014. fda.gov
- Narouze S, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018;43(3):225-262. doi:10.1097/AAP.0000000000000700
Illustration: BruceBlaus, via Wikimedia Commons, CC BY-SA 4.0, cropped.