Percutaneous epidural neuroplasty

Percutaneous epidural neuroplasty (PEN) is a minimally invasive intervention that aims to reduce adhesion-related pain by detaching the adhesions and delivering drugs to the pain-provoking epidural space. Pain may be alleviated by in situ adjuvant treatments with PEN technique. In this section, we covered technical aspects of the PEN, including details about the anatomy, needle navigation, fluoroscopic guidance, and medications. Dural adhesion can be resolved with mechanical shear stress, cutting with hydrostatic pressure, and chemical adhesiolysis. Following a PEN procedure, local anesthetics and steroids may be injected to the spinal canal. Because each patient's situation is unique, different strategies may be required to detach the pain-provoking lesions. Technical failure may lead to complications including dural puncture, epidural hematoma, and neural injury. Compared to the open adhesiolysis of the spinal canal, PEN is a less invasive option that causes less post-operative pain.And it is better than the simple administration of pain-relieving agents over the epidural space of cervical, thoracic, and lumbosacral areas. It is recommended for patients with various spinal diseases, such as post-spinal surgery syndrome, herniated intervertebral discs, spinal stenosis, and any epidural adhesions.