A New Approach to Neuroplasty

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A considerable number of patients complaining of pain after spinal surgery reportedly have adhesions and fibrosis in the epidural space [1,2]. Also, patients with chronic low back pain and/or radicular pain may have perineural adhesions due to perineural and neurogenic inflammation from mechanical or chemical irritation, while they don't have any history of surgery [3,4]. Parke and Watanabe [5] dissected the cadavers of such patients and reported that a number of anterior epidural adhesions, which were not detached even when pulled with threads of about 60 g, were found between L4 and S1. This finding indicates that the adhesions might have been the cause of chronic low back pain. It is still unclear whether adhesions or fibrosis constitute the main cause of low back pain or whether adhesions or fibrosis are the direct cause of pain. Considering the reports currently available, although there is less evidence supporting the postulation that adhesions or fibrosis cause pain directly, it is widely accepted that they are attributed to pain in association with patient's motion [6]. Published reports suggest that the mechanism by which adhesions or fibrosis affect pain may be a disorder of the blood and nutrient supply or repression of the mobility of the dura and dural sleeve. When persisting for a long time, such disorders may cause aggravation of neuritis, demyelination, a nerve conduction disorder, ectopic neural transmission, and, eventually, neuropathic pain [3,5,7-11]. Nonsurgical treatments, such as nerve block, in chronic pain patients with severe adhesions are reported to have a relatively low effect and a high risk for relapse. This may be attributed to the fact that epidural adhesions themselves are difficult to remove through such methods, and also that they interfere with effective spread of a therapeutic agent to the lesion [12]. If a simple nerve block does not have a sufficient effect in a patient with pain caused by adhesions or stenosis, it is important to confirm whether pain is associated with an adhesion and where the adhesion, suspected of being a le-sion, is positioned. Once adhesions or stenosis are confirmed as a cause of pain, neuroplasty may be performed to relieve them. Conventional neuroplasty may be divided into either chemical adhesiolysis using hypertonic saline or mechanical adhesiolysis using a catheter that can be moved laterally. Chemical adhesiolysis is performed …