The history and physical exam should be thorough and note failed conservative therapies and include neural tension tests, neurological changes, and maneuvers that provoke axial and radicular pain. The diagnostic workup should also include radiographic and physiologic exams.
Prior to an invasive procedure such as neuroplasty, other issues must be addressed. The patient must be willing to participate in a multidisciplinary rehabilitation program. Significant psychopathology must be ruled out with psychological testing and evaluation.
Lysis is typically indicated for:
- Failed back surgery syndrome
- Spinal stenosis
- Epidural adhesions
- Chronic back pain from excessive scarring in the anterior lateral epidural space
- Radicular pain unresponsive to epidural steroid injections
Physical therapy is a critical component to further ensure improved, lasting recovery. Healthy nerves should move freely within the IVF to ensure proper blood supply, fluid exchange, and nutrition absorption. An effective method of this nerve root nourishment is routine stretching and exercise.