Epiduroplasty for Failed Back Surgery in St. Louis

Surgery in or near the spinal canal provokes healing, and healing produces scar. In the epidural space that scar, known as peridural or epidural fibrosis, can wrap around and tether a nerve root. The nerve loses its ability to move freely within the canal, and it is also insulated from medication: this is precisely why a standard epidural steroid injection that once worked can stop working.

A catheter is introduced into the epidural space through the sacral hiatus and steered under fluoroscopic guidance to the level of the scarring. Contrast is injected to map the adhesions and to show where medication is failing to spread. The catheter is then used to break down the adhesions mechanically, and medication is delivered directly to the freed nerve root. Contrast is used again at the end to confirm that spread has been restored.

The main indication is failed back surgery syndrome, where leg or back pain persists or returns after an operation that was technically successful. It is also used in some cases of severe spinal stenosis and in patients whose imaging shows adhesions limiting the spread of previous injections. Diagnostic selective nerve root blocks often precede it to confirm which level is responsible.

The procedure is usually performed over one to three sessions on consecutive days, depending on the extent of scarring. It is done with sedation and takes about an hour. Most patients go home the same day and resume light activity within a few days.