Epidural neuroplasty

Step by step

1. 01

   Entry

   The patient lies prone; under local anaesthesia the epidural space is entered with a needle, usually through the sacral hiatus. The patient stays awake and responsive.

   Local anaesthesia, light sedation

   PEN / VERAOne of these options is used, at the physician's choice.

   

   
2. 02

   Epidurogram

   Contrast is injected. Areas where it does not spread show where adhesions (fibrosis) are and which nerve root is affected.

   Contrast 5-10 ml

   
3. 03

   Steering the catheter

   The catheter is passed through the needle and, with its tip bent, advanced under fluoroscopy to the adhesion and the nerve root.

   VERA bidirectional tip, PEN spring-guided catheter

   PEN / VERAOne of these options is used, at the physician's choice.

4. 04

   Release and check

   The adhesion is released mechanically with the catheter tip. Repeat contrast spreading along the nerve root shows the release is adequate.

   Radiopaque, atraumatic tip

   PEN / VERAOne of these options is used, at the physician's choice.

5. 05

   Medication delivery

   Following the physician's protocol, agents such as hyaluronidase, local anaesthetic and corticosteroid are delivered to the target in sequence. The catheter is withdrawn.

   Medication is given through the catheter's injection port

   PEN / VERAOne of these options is used, at the physician's choice.

A general workflow is shown. Practice varies by physician and patient.