by Nicole Berardoni M.D., Paul Lynch M.D., and Tory McJunkin M.D.

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. Epidural lysis of adhesions is a minimally-invasive procedure that was developed in the late 1980s by Dr. Gabor Racz. The procedure has proven effective treating chronic back and neck pain due to scar tissue formation.

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 (Manchikanti 2007). 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.

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 schedule for the Racz 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 (omnipaque, hypertonic saline, hyaluronidase, local anesthetics, and steroids) 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. It is designed to dissolve scar tissue thereby reducing pressure on irritated nerves (Boswell 2007). 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

AdhesiolysisAs with all medications and interventions, there are potential risks of complications. Epidural lysis of adhesions is considered an appropriate treatment for many patients who suffer from back pain, but it does have risks (Boswell 2007). 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. The results of a large study show that epidural lysis of adhesions with hypertonic saline is safe and effective in managing chronic low back and lower extremity pain in patients who failed to respond to other conservative modalities of treatments, including epidural steroid injections (Boswell 2007).

Outcomes

Lysis of AdhesionsThe American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques. In regards to adhesiolysis, the guidelines state that there is strong evidence to indicate effectiveness of adhesiolysis with epidural steroids for short- and long-term pain control in refractory pain and radiculopathy.

One of the large retrospective studies showed at less than three months 100% of the patients treated had pain relief (Boswell 2007). Another study indicated that overall health status improved significantly in the patients treated with adhesiolysis. Patients stated that their pain and pain medication use were decreased and their physical health, mental health, functional status, and psychological status were all increased after undergoing adhesiolysis therapy (Manchikanti 2001). Drs Lynch and McJunkin trained under Dr. Gabor Racz, the inventor of the adhesiolysis procedure (Racz Procedure), and learned this safe innovative technique from him first-hand. If you are suffering from chronic back or neck pain that has been refractory to other treatments contact. Arizona Pain Specialists today to see if you can benefit from this innovative treatment.

At Arizona Pain, our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

Journal Articles

  1. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
  2. Percutaneous lysis of epidural adhesions. Manchikanti L, Bakhit CE. Pain Physician. 2000 Jan;3(1):46-64 PMID: 16906207
  3. Systematic review of effectiveness and complications of adhesiolysis in the management of chronic spinal pain: an update. Trescot AM, Chopra P, Abdi S, Datta S, Schultz DM. Pain Physician. 2007 Jan;10(1):129-46 PMID: 17256027
  4. Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial. Manchikanti L, Pampati V, Fellows B, Rivera J, Beyer CD, Damron KS. Pain Physician. 2001 Apr;4(2):153-66 PMID: 16902688
  5. Transforaminal ventral epidural adhesiolysis. Hammer M, Doleys DM, Chung OY. Pain Physician. 2001 Jul;4(3):273-9 PMID: 16900254