What is Racz Procedure or  Lysis of Adhesions?

 

  • RACZ PROCEDURE or Lysis of adhesions is a procedure designed mainly to relieve pain resulting from back surgeries or irritation related pain caused by a herniated discs.
  • Surgery on the spine can occasionally result in scar tissue around spinal nerves. Approximately 10% to 25% of spinal surgery procedures give rise to these scars.
  • Scar tissue can lead to compression, inflammation, or swelling in spinal nerves. It can also cause stenosis in the spine and pain in the “tailbone” (or sacroiliac joint)

 

 

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RACZ PROCEDURE or Lysis of adhesions is a procedure designed mainly to relieve pain resulting from back surgeries or irritation related pain caused by herniated discs. Surgery on the spine can occasionally result in scar tissue around spinal nerves. Approximately 10% to 25% of spinal surgery procedures give rise to these scars. The result is a fresh reoccurrence of pain from scar tissue growth in the epidural space of the vertebrae affected. Scar tissue can lead to compression, inflammation, or swelling in spinal nerves. It can also cause stenosis in the spine and pain in the “tailbone” (or sacroiliac joint). Lysis of adhesions is performed to dissolve (i.e. lyse) the scar tissue (also known as adhesions). This has been shown to give relief from surgically-acquired pain in both the short and longer term.

How are Lysis of Adhesions Performed?

racz2Lysis of adhesions is also known as the Racz procedure. In the course of this procedure, a local anesthetic is injected into the affected area to numb it. Visualization methods, most often fluoroscopy or magnetic resonance imaging (MRI), locate the scar tissue and the area to be injected. Endoscopy, where a thin camera probe is inserted into the region to be treated, is also often incorporated in lysis of adhesions procedure’s and give additional accuracy and visualization.

A catheter is guided to the precise location of the scar tissue and delivers a combination of compounds into the scar tissue to break up or dissolve it. The compounds injected are saline (the injection vehicle) and hyaluronidase, an enzyme that breaks up scar tissue at a molecular level. Omnipaque, which improves the visibility of the area under fluoroscopy, anesthetics to relieve the pain, and steroids to treat inflammation are also included in the injected formulation.

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The risks of lysis of adhesions are mainly related to the placement of the needles in the course of the procedure. The needles are directed at the dural space, a specific location within a bone of the spine (i.e. a vertebra). If this is somehow off-target, the drugs could be injected into other areas, such as the subarachnoid space. If this occurs, it could result in nerve damage. Other complications include temporary spinal blockade that may cause temporary movement problems or a decrease in sensation. A headache, known as a lumbar puncture headache, is more common following the lysis of adhesion procedure, but this again is temporary and usually doesn’t require treatment. Catheter shear, or damage to nerves, skin, or muscles occurring as the catheter supplying the medications is used is also possible.

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The drugs injected have a low incidence of producing side effects as a result of their use in the lysis of adhesions. Steroids can cause arthritis, elevated blood sugar, and weight gain. They can also result in stomach ulcers and deficiencies in the immune system. The local anesthetics used may cause nerve desensitization and interact with other medications taken by the patient to produce adverse effects. In some cases, temporary neurological deficits, or reactions to local anesthetics, such as chest pain, respiratory depression, and nausea can occur.

Conditions Related To Lysis of Adhesions

racz procedure web 4Lysis of adhesions is used to treat scarring left by surgeries performed on the spine or scar tissue secondary to irritated or rupture HERNIATED DISCS. It is most often employed when procedures on the lower back (the iliosacral joint) result in scarring. This results in irritation or inflammation caused by the scar tissue and thus a new source of pain. Scarring can also result in stenosis or compression of the spinal nerves. Stenosis can cause pain, abnormal sensation, or even a lack of sensation, which can lead to paralysis in extreme cases. Lysis of adhesions results in significant pain relief and at least a 50% regain of normal function in approximately 70% of patients.
 The effects of the procedure are reported to last for four to twelve weeks after treatment. Though it is most strongly associated with lower back pain, a clinical trial evaluating the use of lysis of adhesions for treating cervical stenosis showed good results. Cervical stenosis is a compression of spinal nerves in the neck that causes chronic pain in that area. The use of lysis of adhesions resulted in pain relief for 77% of patients in this trial after six months of treatment.

Conclusion

racz procedure web 1Lysis of adhesions is a treatment designed to reduce scar tissue (adhesions) left by spinal surgeries. This scarring can result in inflammation or irritation of the nearby nerves, thus causing pain. Lysis of adhesions, also known as the Racz procedure, involves epidural, or direct, injections into the region(s) of the spine affected by scarring. These injections deliver anesthetics to relieve pain, compounds that dissolve the scar tissue, and steroids to reduce inflammation.

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The main risks of Racz are related to misplacement of the needles used; however, this risk can be reduced by the use of visualization methods, such as fluoroscopy or endoscopy, to ensure accuracy. Lumbar puncture headaches and sensory deficits are more common side-effects associated with lysis of adhesions, but they are not serious or long-lasting.
Lysis of adhesions is most commonly used to treat lower back pain or stenosis resulting from surgery but has also shown potential in treating cervical stenosis, which causes neck pain. This procedure is safe, effective, and relieves pain in the short and medium term.

 

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