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What is Epidural Lysis of Adhesions?

Most commonly known as the Racz ® Procedure, Lysis of Adhesions (a.k.a Lysis of Adhesions, Percutaneous Neuroplasty, and Adhesiolysis) was invented and developed by Dr. Gabor Racz in the 1980s during his tenure as Chairman of the Department of Anesthesiology at Texas Tech University Health Sciences Center in Lubbock, Texas.

Pain Physician, Volume 3, Number 3, pp 262-270
2000, Association of Pain Management Anesthesiologists
Susan R. Anderson, MD, Gabor B. Racz, MD, and James Heavner, DVM, PhD

Review Article, Evolution of Epidural Lysis of Adhesions

Origins

Treatment of chronic pain dates back as early as 1863. This is when we find the first reports of subcutaneous injections, being administered by Luton, to treat chronic pain.

Moving forward over 125 years, we find the origins of Lysis of Adhesions, sometimes referred to as the Racz Procedure. This interventional technique is unique in that it involves site-specific catheter placement and injectates of various medications intended to “open-up” the perineural space. These injected medications are intended to increase nerve root mobility and reduce inflammation associated with swollen and painful nerve roots exiting the spinal canal via the intervertebral foramen.

The first report of this procedure was by Dr. Racz and Holubec in 1989. The results were based on a survey of seventy-two patients who were randomly selected from approximately 200 patients who underwent caudal neuroplasty (lumbar Lysis). There were slight variations in the protocol, namely the volume of bupivacaine used (25 mL instead of 10 mL) and the omission of hyaluronidase. Approximately 72.2% of the patients reported pain relief on discharge, while 37.5% had pain relief of less than 1 month, 30.0% reported pain relief of 1 to 3 months, and 12.5% had relief for 3 to 6 months.

When the technique of epidural neuroplasty (Lysis of Adhesions) was first developed, the catheter was inserted into the posterior epidural space. As more and more procedures were performed, it was noted that the posterior epidural space was difficult to access in some patients who had undergone surgical procedures for discogenic or radicular pain. This was most likely due to scar tissue formation from the previous surgery.

Indications

Epidural Lysis of Adhesions has been proven effective in treating chronic pain due to scar tissue formation*. This treatment is most often performed on patients with Failed Back Surgery Syndrome (FBSS), spinal stenosis, and radiculopathy. It can also be effective in treating leaky disc’s and many situations in which excessive scarring exists in the anterior lateral epidural space.

Procedure

A specially designed, sheer resistant needle and Racz ® Catheter are guided into the epidural space – under the assistance of fluoroscopic imaging – of the consciously sedated patient into the target area. Corticosteroids, Hyaluroniadase, or hypertonic solution is then delivered, allowing restrictive scar tissue to dissolve and free compromised nerve roots, therefore relieving pain.

Recovery

Patients begin basic stretching exercises (neuroflossing) immediately after the procedure is complete. In most cases, Epidural Lysis of Adhesions can be done in an outpatient setting and the patient may return home on the same day. Patients who have excessive amounts of scarring may require an additional two to three injections, completed in accordance with individual physician protocol.

Results

Most patients will begin to experience improvement within several days of the procedure. Some patients will experience immediate relief; some may require several weeks to realize measureable improvement. Most patients are able to return to work the day after the catheter is removed.

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Date: Sep 30-Oct 1, 2022
Location: Dallas, TX

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