Hyaluronidase in Neuroplasty: A Review

Background: Neuroplasty, also known as percutaneous adhesiolysis, is an effective treatment forpersistent axial and radicular pain.Objectives: One issue of concern is whether hyaluronidase should be used when performingneuroplasty. The objective of this narrative review is to evaluate the current literature relating tohyaluronidase and its role in neuroplasty.Methods: The literature relating to hyaluronidase was examined via a search of PubMed andGoogle Scholar until April 2019, review of the citations of relevant literature, and the authors’knowledge of the literature and activity in the field. The literature was reviewed in light ofhyaluronidase’s physiologic role, allergenicity, medical uses, and evaluation specifically forneuroplasty.Results: Hyaluronidase facilitates the spread of medications in the extracellular matrix by breakingdown polysaccharides in the interstitial space. While allergic reactions to hyaluronidase havebeen reported, these reactions occurred with animal-derived preparations. The current humanrecombinant hyaluronidase does not have any reports of allergic reactions. Laboratory studiesshow that it does not evoke an immune response. Hyaluronidase has been extensively used in avariety of medical applications, including intrathecal treatment of arachnoiditis.There have been multiple studies reporting benefit from the use of hyaluronidase in interventionalprocedures. One randomized trial specifically looking at the use of hyaluronidase in neuroplastyfound that the addition of hyaluronidase improved pain ratings at 12 months compared to othertechniques and decreased the number of procedures needed to gain effect.Limitations: There have been limited studies examining the enhanced efficacy of neuroplastywhen hyaluronidase is added.Conclusions: Because of enhanced efficacy and safety, and because of the decrease in thenumber of procedures needed to be performed, hyaluronidase should be considered whendeciding which medications to use when performing neuroplasty.Key words: Neuroplasty, adhesiolysis, hyaluronidase, spinal stenosis, failed back surgerysynderome, post lumbar surgery syndrome