Treatment

Adhesiolysis

What is adhesiolysis?

Epidural lysis of adhesions is known as adhesiolysis or the Racz Procedure. The procedure’s name comes from “adhesion” meaning scar tissue and “lysis” meaning to dissolve or destroy. The procedure has proven effective treating chronic back and neck pain due to scar tissue formation.

What causes scar tissue to form?

Scar tissue can form around nerve roots causing constant unrelenting pain. Adhesions are typically formed due to inflammation and irritation in the epidural space. These adhesions can aggravate nearby nerve roots causing intense pain. Scar tissue can frequently result in irritated and inflamed nerves, which can cause pain that radiates from the low back into the legs. Most commonly, people who present with neck or back pain due to scar tissue formation have had prior surgeries or prolonged neck or back pain. After spinal surgery, adhesions develop and are thought to be the cause of recurrent pain.

Before the procedure

Before performing a procedure, your pain physician will review your MRI in order to identify which nerves are likely affected and responsible for your pain. Initially, a series of epidural steroid injections are often performed to localize and treat your pain. If scar tissue is the cause for your pain then the response to the epidural steroid injections may be limited. Once scar tissue is thought to be the cause of your pain, you will be scheduled for the Racz Procedure.

During the procedure

Epidural lysis of adhesions is performed by injecting a local anesthetic with a small needle into the skin above your buttock. Once the area is numb, a larger needle with a catheter/guide wire is placed into the epidural space using X-ray guidance for proper placement. Once the catheter is in the proper location where the scar tissue is affecting the nerve root, multiple medications are injected into the space in order to dissolve the scar tissue and reduce the inflammation and irritation on the nerve.

This procedure can be performed over a two-day period with another injection of materials through the catheter the following day to ensure lysis of scar tissue has been achieved.

The entire procedure typically is finished in less than an hour and is performed on an outpatient basis, so typically you are able to go home within a few hours of the procedure. Immediately after the injection you may notice that your legs feel heavy and may have some sensory changes, but these are temporary. The local numbing anesthetic wears off in a few hours, so you may feel some discomfort once that wears off at the injection site. The inflammation-reducing steroid generally starts working at about 48 hours.

Benefits

The Racz Procedure is considered safe and effective. The purpose of the procedure is to minimize the deleterious effects of epidural scarring, which can physically prevent direct application of drugs to nerves (epidural steroid injections) and other tissues in the treatment of chronic back pain. There is strong evidence for short term and moderate evidence for long-term effectiveness of epidural lysis of adhesions. Most people who receive the treatment experience significant pain relief, with 50% or more reduction in pain (Trescot 2007).

Risks

As with all medications and interventions, there are potential risks of complications. The most common complaint is mild to moderate back pain at the injection site shortly after the procedure. Other more serious and far less common complications include spinal cord compression, excessive intracranial pressure, bleeding, subdural injection, hematoma, or infection. These particular risks are decreased by the use of X-ray imaging, sterile techniques, and adequate training.

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