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Multilevel neuroplasty

Jamal Ahmed on November 26, 2018 at 9:21 am
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    • Jamal AhmedJamal Ahmed
      Participant
      Joined: Oct 25, 2017
      Posts: 4
      #46813

      I many case of epidural adhesion, the pathology is not a single side or even a single level, in these cases where should I leave my catheter after doing adhesolysis?

      • Gabor B RaczGabor B Racz
        Participant
        Joined: Mar 28, 2016
        Posts: 30
        #46834

        Jamal,

        Make sure you do a dural tug examination! If that is positive it means the dura is adherent to the posterior longitudinal ligament. The target for leaving the catheter will be different.

        The examination needs to be done and your first procedure will need to be to the ventral lateral epidural space on the worst side of the patient’s pain. After you do the 3 times hypertonic technique the patient may report pain from the other side or a different level months or even years later.

        Not uncommonly, I will place a second catheter transforaminally to the ventral mid canal in cases of spinal stenosis. Read the introductory chapter and Lysis Neuroplasty Chapter 8 in the 2nd Edition of Techniques of Neurolysis.

        Best,

        Dr. Gabor B. Racz

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