Percutaneous epidural neuroplasty

Percutaneous epidural neuroplasty (PEN), also known as percutaneous epidural neurolysis, percutaneous epidural adhesiolysis, or the Racz procedure, is a minimally invasive spine intervention. The purpose of PEN includes lysis of epidural scar, targeted drug delivery, ventral drug instillation, and neural decompression{Oh:2017wv, Ji:2015kra, Lee:2016tj, Ji:2016vy, Oh:2014wc}. A catheter is advanced to the target site where epidurogram reveals adhesion, and adhesiolysis is performed. The technique of adhesiolysis consists of mechanical lysis by the catheter, chemical lysis with hyaluronidase, and hydrostatic lysis by saline and contrast media. PEN has been used to treat chronic pain resulting from post spinal surgery syndrome wherein scar tissue has formed in the epidural space (Manchikanti et al., J Pain 5:597, 2012; Manchikanti et al., Pain 12:E355-E368, 2009; Heavner, Anesth Pain Med 24:202-207, 1999; Manchikanti et al., Pain 7:177-186, 2004; Veihelmann et al., J Orthop Sci. 11:365-369, 2006). Evidence suggests the procedure may also be effective in treating spinal stenosis and radicular pain caused by herniated lumbar disc (Manchikanti et al., J Pain 5:597, 2012; Manchikanti et al., Pain 12:E341-E3541, 2009; Park et al., Pain Phys 14:377-382, 2011; Ji et al., Yonsei Med J 56:691-697, 2015).