What is neuroplasty?

Neuroplasty: Definition and Clinical Applications

Neuroplasty is the decompression of intact nerves, which involves freeing nerves from surrounding adhesions, scar tissue, or other compressive elements to restore their normal function. 1

Understanding Neuroplasty

Neuroplasty refers to a specific surgical or minimally invasive procedure designed to relieve nerve irritation and compression. It differs from:

• Nerve injection (which involves injecting anesthetic agents into a nerve)
• Nerve destruction (which involves deliberately damaging or ablating nerve tissue)

Mechanisms and Principles

Neuroplasty works through several key mechanisms:

• Mechanical decompression of nerves trapped by scar tissue, adhesions, or anatomical structures
• Release of perineural fibrosis that compromises intraneural microcirculation
• Restoration of normal nerve mobility and function
• Reduction of inflammation surrounding the nerve

Clinical Applications of Neuroplasty

Neuroplasty is primarily used in the following clinical scenarios:

1. Epidural Neuroplasty

   • Used for chronic refractory low back and/or lower extremity pain
   • Particularly effective for lumbar disc herniation, spinal stenosis, and failed back surgery syndrome 2
   • Can be performed using various approaches:
     • Caudal approach
     • Transforaminal approach
     • Interlaminar approach
     • Retrodiscal approach 3

2. Peripheral Nerve Neuroplasty

   • Used for entrapment neuropathies (e.g., ulnar nerve entrapment at the elbow)
   • Involves formal neurolysis under magnification to free the nerve from all potentially compressing structures 4

3. Balloon Neuroplasty

   • Percutaneous epidural balloon neuroplasty (PEBN) combines balloon decompression with conventional neuroplasty
   • Shows superior outcomes compared to conventional percutaneous epidural neuroplasty
   • Effective for patients unresponsive to conventional neuroplasty 3

Predictors of Successful Neuroplasty Outcomes

The following factors are associated with better outcomes:

• Chronic lumbar radicular pain without significant back pain
• Neurogenic claudication
• Minimal neuropathic component
• Short duration of pain after lumbar surgery
• Foraminal stenosis caused primarily by degenerative disc
• Mild foraminal stenosis
• Perineural adhesion by degenerative discs 3

Technical Considerations for Successful Neuroplasty

For optimal outcomes, the following technical aspects are important:

• Complete decompression of the nerve at all potential sites of compression
• Adequate ballooning (≥50% of target sites in balloon neuroplasty)
• Complete contrast dispersion after ballooning
• Proper placement of the nerve in a well-vascularized bed following decompression 4, 3

Clinical Evidence Supporting Neuroplasty

Multiple studies have demonstrated the effectiveness of neuroplasty:

• Epiduroscopic laser neural decompression (ELND) showed symptom relief in 87% of patients after 2 weeks and 81.8% after 1 month 2
• Percutaneous epidural balloon neuroplasty has demonstrated significant pain relief and functional improvement with effects lasting up to 12 months 3
• Caudal epidural neuroplasty significantly reduces pain scores and medication requirements in patients with lumbar epidural fibrosis 5

Important Considerations and Pitfalls

• Failure to decompress all potential sites of compression is a common cause of persistent symptoms after initial neuroplasty
• Postprocedural home exercises are an integral part of successful neuroplasty treatment 6
• Neuroplasty should be considered prior to more invasive surgical interventions for persistent back and/or extremity pain 6

In summary, neuroplasty is a decompressive procedure for intact nerves that has demonstrated effectiveness in treating various pain conditions related to nerve compression and irritation, particularly in the spine and peripheral nervous system.