Percutaneous Epidural Neuroplasty

Percutaneous epidural neuroplasty (PEN) is a minimally invasive spine management technique. It is referred to as percutaneous epidural neurolysis, Racz procedure, or the percutaneous epidural adhesiolysis. PEN plays a role in epidural scar dissolution, target drug delivery, ventral space drug injection, and the nerve decompression [1, 2]. After inserting a catheter into the target area where adhesions are visible on epidural examination, adhesiolysis is performed. A soft or navigable catheter system can be used to successfully advance the catheter to the target site in the epidural space. The adhesiolysis technique consists of mechanical dissolution using a catheter, chemical dissolution using hyaluronidase, and hydrostatic pressure dissolution using physiological saline and a contrast medium. The navigable catheter is more useful for mechanical lysis because the catheter tip can be moved from side to side.