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Neuroplasty Pain Relief at Our Los Angeles Center

Neuroplasty is a minimally invasive treatment designed to address chronic back pain by reducing inflammation and scar tissue in the spine. The procedure is sometimes called epidural adhesiolysis because the intervention helps release adhesions in the epidural space in the spine (the narrow area between the discs and the surrounding membrane). The nerves that run through this space may be negatively affected by scar tissue that forms after injury or surgery. They may get compressed or trapped in one position. This constant pressure and irritation may cause the nerves to swell, leading to ongoing pain that radiates into the legs or other areas depending on where the adhesions are located in the spine.

Problems Treated by Neuroplasty

The most common symptoms treated by this procedure include ongoing neck, back or leg pain. The pain may be chronic, or it may flare up and subside. The pain or other uncomfortable sensations may be called different medical terms depending on the symptoms and the affected structures in the body. For example:

  • Neuralgia: damage or disorder in the peripheral nerves causing pain spasms radiating into the neck and head
  • Sciatica: damage or disorder of nerves in the lower spine causing pain spasms radiating into the lower back and legs
  • Neuropathy: signs of nerve damage that may include pain, tingling, numbness, and motor control problems in the limbs

Who Is a Candidate for Neuroplasty?

When pain is significant enough to impair normal activities and quality of life, a patient may benefit from epidural neuroplasty. Patients who do not respond to more conservative treatments such as oral medications or physical therapy may be candidates for this procedure. It may be recommended for patients with a wide variety of conditions affecting the interior of the spine such as:

  • Spinal stenosis (narrowing of the openings through which nerves run)
  • Ongoing pain after back or neck surgery (either caused by post-surgical scarring or because the surgery failed to resolve pre-existing pain)
  • Patients who cannot have surgery or who do not want surgery for spinal problems
  • Ruptured, bulging, or degenerated discs
  • Degenerative arthritis causing problems such as facet pain (linked to excessive wear on the vertebral joints)
  • Compression fractures in the vertebrae
  • Pain not resolved by opioids pumped directly into the spine or by spinal cord stimulation
  • Epidural fibrosis or inflammation
  • Sciatica from lumbar radiculitis (pinched or irritated nerves causing pain to radiate into the legs)
  • Facet pain (caused by problems in the vertebral joints)

How Does Neuroplasty Work?

This procedure is designed to resolve or limit ongoing pain symptoms by the introduction of a blend of medications into the area around scar tissue and nerve adhesions. Each substance has a distinct purpose in treating the underlying causes of nerve pain. They work to:

  • Reduce inflammation (swelling from irritation of the nerve tissues by toxins or pressure from scar tissue)
  • Reduce edema (swelling of the tissues from water retention)
  • Increase fluid volume in the epidural space (giving the nerves more room)
  • Dissolve or break down adhesions and scar tissue (releasing the nerves from being pinched, stretched or compressed)
  • Disrupt the pain signals in the nerves temporarily (sometimes interrupting the nerve feedback for just a short period of time is helpful in resolving chronic pain)

Procedure Overview

This is an outpatient procedure that is done using a local anesthetic to manage discomfort. Patients may also be given a mild sedative to help them relax and remain still during the procedure. The patient lies face down and the area of the back that will be treated is exposed. The surgeon injects a contrast dye into the epidural space so that it will show up clearly on an x-ray screen in real time (this is called fluoroscopy). This technique allows the surgeon to see the scar tissue and carefully introduce a catheter (narrow, hollow tube) into the spine to deliver the medications to just the right area. If needed, a tiny balloon may be inserted into the area to widen the epidural space and relieve pressure on the nerve.

The recovery period is very short and most patients are up and walking as soon as the local anesthetic wears off. They can be driven home the same day. It may take up to several weeks to feel the full benefits since the medications need time to work to reduce swelling and adhesions. Light physical therapy to strengthen the back and some medications to reduce inflammation may be recommended during the recovery period.

Risks, Side Effects and Benefits

Because neuroplasty is minimally invasive and guided with a fluoroscope, it is a low risk procedure. Many patients experience noticeable, long lasting reduction of their pain after the treatment. Return to normal, non-strenuous activities is also swift based on the patient’s response to treatment.

This procedure rarely causes any significant complications. Side effects may occur if medications are accidentally introduced into the surrounding tissues rather than directly into the target area. Nerve damage, infection and other serious complications are extremely uncommon. The most common risk is simply that the procedure may not deliver the desired level of relief. Some patients do need multiple treatments or maintenance treatments. This procedure does not treat the underlying degenerative conditions that caused adhesions and inflammation in the first place. Continued wear and tear on the spine can cause symptoms to recur. It is very important for patients to understand the pros and cons of this treatment to manage expectations.

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