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Epidural Lysis of Adhesions with Catheter Placement

What is an Epidural Lysis of Adhesions with Catheter Placement?

Also called Racz procedure, this procedure is performed to remove excessive scarring in the epidural space. The epidural space is a thin area between the inside of the spine and the protective layer around the spinal cord. Fibrous epidural lesions can develop after spinal surgery, or can occur secondary to an annular tear, hematoma or infection. Scar tissue may restrict the natural movement of nerves causing inflammation and pain. Patients who have had prior neck or back surgery but still have persistent pain may benefit from this procedure. Patients who have herniated disks that are not surgically correctable may also receive pain relief from this procedure.

This technique is accomplished by the use of a catheter (tube) which physically breaks up scar tissues as well as medications that help to soften scar tissue. It is done with the use of a fluoroscope (x-ray machine) to assist the physician in placement of the catheter.

What are the pre-requisites in order to perform this procedure?

You may need to stop taking certain medications several days before the procedure, especially anticoagulant or “blood thinning” medications, as well as other prescription and/or over the counter medications, including herbal and vitamin supplements.

Will the procedure hurt?

Mild sedation will be administered to ease any anxiety; however, general anesthesia is not an option since your participation in the procedure is critical to reduce the risk of any complication. The physician will inject local anesthetic to numb up the area prior to placing the catheter through the skin. Once the local anesthetic has set in, the epidural needle will then be introduced through the skin and into the sacral hiatus.

What should I expect after the procedure and what are the side effects?

Pain may increase in the first 48-72 hours because of the mechanical forces used to break up the scarring. The beneficial effects are usually appreciated 2-4 weeks following the procedure. In general, this procedure improves symptoms temporarily, but pain relief can sometimes last for months to years. If necessary, the procedure can be repeated. Because epidural scarring is a difficult problem to treat, some patients may not experience any relief.