Epidural Lysis of Adhesion

The epidural space surrounds the spinal cord and spinal nerves, and insulates them from the spine bones and disks. Many things can irritate the spinal cord or spinal nerves and cause pain, numbness, and weakness. Epidural adhesions (e.g. scar) can be a result of inflammation, previous surgery, trauma, and a number of different other processes. Through chronic irritation of nerve roots, pain may persist for a long time. Examples would include herniated or bulging disks, bone spurs, spinal stenosis, arthritis changes, or scar tissue from previous spine surgeries. This type of pain, referred to as radicular or sciatic-like pain, is felt in the area of the body that the irritated nerves(s) go to (innervate). If the irritation or inflammation is treated effectively, then possibly all of the pain, numbness, or weakness will resolve and never return, thus preventing the need for surgery.

It is often difficult to diagnose epidural adhesions using conventional methods such as x-rays and Cat Scan. By injecting contrast (a.k.a. dye material) directly into the epidural space, one can assess the extent of scarring in that area.

In the Racz procedure, after having an IV, you will lie down on your belly. A small injection of the numbing medicine will be given in area of your tailbone. A guide needle will then be placed in that area and through it a small catheter with guide wire will be placed into the epidural space. This can be done even if you had previous surgery and fusion in your lower back area. With the help of the dye material, guide wire, and the catheter, your doctor will attempt to take down some of the scar tissue and inject medication directly into the problem areas which otherwise would not accessible through regular epidural injections. As with other type of epidural injections, there is a chance of having a headache after the procedure that is usually self-limited.

Recently, newer techniques have become available. These include use of steerable catheters and endoscopy equipments to tackle the problem of adhesions and catheter directed nerve root injections. VuCath and TargetCath are two examples of these.

Tip:

Another form of this procedure is also known as Lumbar Nerve Root Decompression.

A variant of this is called the RACZ procedure.