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Neural Mapping & Neural Flossing Specialist

LA Pain

Interventional Pain Medicine Specialist located in Los Angeles, CA & Oakland, CA

Low back and leg pain has many causes, one of which is scarring in the epidural space, the area between the spinal cord – along with nerves that go to the arms and legs – and the spine itself. Epidural scarring can cause back pain, leg pain, and arm pain. Scars can trap the nerves and make them unable to move when you change position. Scarring can even prevent medicine injected into the epidural space from getting to the nerves, making epidurals ineffective. Dr. Enayati and Dr. Gruver are Neural Mapping & Neural Flossing Specialists located in Beverly Hills.

Neural Mapping & Neural Flossing Q & A

Neural Mapping

Epidural scarring is not predictably or reliably imaged using MRI imaging. Neural Mapping is the only procedure to accurately diagnose and map out scar tissue around the spinal cord and nerves. Under sterile conditions, Dr. Enayati and Dr. Gruver inject a special type of epidural needle into the spinal column, through which a catheter is inserted around the spinal cord and the nerves that come from the spinal cord. Dr. Enayati then injects contrast dye through the needle, so that the scar tissue shows up on a live fluoroscopy x-ray. Dr. Enayati then repositions the catheter repeats the process multiple times to obtain a clearer picture of the scarring.

Neural Flossing

When patients have not responded to epidurals, physical therapy or medications, Neural Flossing may be able to finally provide relief. The purpose of this procedure is to break up scar tissue that has built up in the epidural space. Scarring can come about from surgery or simply from aging of the spine. Dr. Enayati and Dr. Gruver insert an advanced catheter into the scarred area and uses a sophisticated mechanical technique to break up adhesions and scarring with the catheter. Throughout the Neural Flossing procedure, Dr. Enayati uses Neural Mapping to see the scaring and to observe its resolution. Dr. Enayati also injects several medications and fluids to break up the scar tissues at various sites around the spinal cord and nerves. Dr. Enayati may also use an enzyme called hyaluronidase (Hylinex) to help dissolve the scar tissue.

"The evidence is Level I or strong that percutaneous adhesiolysis is efficacious in the treatment of chronic refractory low back and lower extremity pain. Percutaneous adhesiolysis may be considered as a first-line treatment for chronic refractory low back and lower extremity pain.”

Percutaneous and Endoscopic Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis
Pain Physician 
2016; 19: E245-E281

Have Dr. Enayati and Dr. Gruver had good results with this procedure? Who is an ideal patient?

Dr. Enayati and Dr. Gruver have had excellent results with this procedure, but he also selects patients carefully, in order to increase the likelihood of excellent results. Ideal candidates are patients who have had lumbar or cervical surgery and experience numbness or burning in the legs or arms, and patients with spinal stenosis who experience burning or numbness or weakness in the legs or arms with activity.

Patients often notice significant results almost immediately. They will continue to have improvements over the next few weeks. Occasionally the procedure will be repeated one or two more times for maximum effect, depending on the extent of scar tissue formation.

Why should I have Dr. Enayati or Dr. Gruver perform this procedure instead of the Laser Spine Institute or any other pain doctor?

Dr. Enayati and Dr. Gruver were trained in this procedure during their Pain Medicine Fellowship at Mt. Sinai School of Medicine’s Manhattan Center for Pain Management. He has performed Neural Flossing successfully on many patients, with life-altering results. Patients who had been taking narcotics for chronic burning leg and low back pain finally became free of pain and were able to stop taking narcotic medication. One patient told Dr. Enayati that she was able to return to hiking and running. And these results and stories are more common than not from Dr. Enayati’s Neural Flossing patients.

Dr. Enayati and Dr. Gruver have developed proprietary techniques for this procedure. Although he has attempted to teach several other pain specialists these advanced skills, the manual dexterity and precision required to perform his techniques are rare. Dr. Enayati and Dr. Gruver have also developed a special technique for combining stem cell allografting into the Neural Flossing procedure for select patients, in order to regenerate the sheath around the nerves coming from the spinal cord and promote long-term healing.